Patient-provider Interactions Research Articles

Psychometric Evaluation of the Trauma-Informed Care Provider Assessment Tool.

The increasing recognition of adverse childhood experiences as a significant factor in adult health outcomes underscores the need for trauma-informed care (TIC) in healthcare settings. The purpose of this study was to assess the psychometric properties of the TIC Provider Assessment Tool (TIC-PAT) designed for primary care providers. The TIC-PAT aligns with the TIC Pyramid framework and assesses both universal trauma precautions and trauma-specific care. A total of 176 primary care providers in the United States completed the TIC-PAT through an anonymous online survey. Findings through exploratory and confirmatory factor analyses revealed a unidimensional (one-factor) model, consolidating questions into a concise 10-item measure. This study contributes an efficient assessment tool for the provision of TIC by primary care providers in healthcare settings, promoting better patient-provider interactions and enhancing provider awareness of trauma's impact on health.

Patient Satisfaction with Antiretroviral Therapy Services in Hadiya Zone, Central Ethiopia Using the Donebidean Model: A Time-Motion Study.

A time-motion study is a scientific method for recording time spent on various tasks in a narrow range of specialized work settings, beginning with initial enrollment in ART provision. Therefore, the study aimed to assess the time motion of patient satisfaction with antiretroviral therapy services in Central Ethiopia. A facility-based cross-sectional study was conducted on a sample of 422 patients from June 14 to July 30, 2021. We used a simple random sampling technique to select the participants. Structural input-related qualitative data were collected using an in-depth interview and used for concurrent triangulation with quantitative. Quantitative data were collected using a standardized and pre-tested questionnaire and analyzed using SPSS version 24.0. Bivariate and multivariable logistic regressions were used to identify independent predictors of time motion and patient satisfaction. The degree of association between the outcome and independent variables was assessed by using an odds ratio with a 95% CI. The time motion of patient satisfaction study found that 53.1% (224/422) of the study participants were satisfied. As independent predictors, time spent (time motion) waiting to be seen by a health professional (AOR = 0.228, 95% CI = 0.079-0.661), patient-provider interaction (AOR = 3.72, 95% CI = 2.111-5.771), perceived privacy (AOR = 2.912, 95% CI = 1.76-2.78), sex (AOR = 2.499, 95% CI = 1.556-4.009), and income class (AOR = 0.228, 95% CI = 0.073-0.707) were associated with outcome variable. The study found low patient satisfaction with ART services, indicating the need for further improvement to enhance patient-centered services with the given time motion. Therefore, further research is needed to assess the intensity and reach of the information through an analysis of pre- and post-intervention that provides a complete picture of conceptualizations of time motion studies.

The Impact of Providers as Health Discussants on Black Women's Interest in PrEP for HIV Prevention.

This study sought to examine the role of providers as health discussants (HD) on interest in preexposure prophylaxis for HIV prevention in a national sample of adult Black cisgender women (N = 315). Health discussant networks, a type of social network, may be influential in HIV prevention efforts. These networks, often composed of individuals' families, have improved health utilization outcomes in other disciplines. However, health discussants in HIV prevention are understudied, especially when considering providers as network members. We conducted a cross-sectional online survey and collected socio-demographic information, sexual history, HIV concerns, PrEP attitudes, healthcare utilization, mistrust, social support, and HD information. We used descriptive statistics and logistic regression to analyze data. Associations between PrEP interest and variables were examined. We found that older, partnered, who had recent healthcare visits or health insurance were more likely to involve healthcare providers as discussants. Anticipated PrEP stigma decreased provider involvement. Among participants listing providers as discussants, there was a greater likelihood of interest in using PrEP. Our findings indicate that healthcare provider support and social factors are crucial in promoting PrEP engagement among Black women. Integrating social dynamics and positive provider-patient interactions is essential for successful PrEP implementation.

The impact of automatic history-taking software on data quality in the cardiology outpatient clinic: Retrospective observational study.

Healthcare delivery now mandates shorter visits despite the need for more data entry, under-mining patient-provider interaction. Furthermore, enhancing access to the outcomes of prior tests and imaging conducted on the patient, along with accurately documenting medication history, will significantly elevate the quality of healthcare service delivery. To enhance the efficiency of clinic visits, we have devised a patient-provider portal that systematically gathers symptom and clinical data from patients through a computer algorithm known as Automated Assessment of Cardiovascular Examination (AACE). We intended to assess the quality of computer-generated Electronic Health Records (EHRs) with those documented by physicians. We conducted a cross-sectional study employing a paired-sample design, focusing on individuals seeking assessment for active cardiovascular symptoms at outpatient adult cardiovascular clinics. Participants initially completed the AACE, and subsequently, in the first protocol, patients were subjected to routine care without providing the AACE forms to examining physicians. In the second protocol, the AACE form was presented to the physician before the examination, and participants were subjected to routine care. We assessed the impact of AACE forms generated through computerized history-taking method on the examination, considering various clinical outcomes and satisfaction surveys. We included non-randomized eligible patients who visited seven general cardiology outpatient clinics between September 18, 2023, and October 27, 2023. These clinics were staffed by the same physicians who were unaware of the content and details of the study. A total of 762 patients (394 patients in protocol 1 and 368 patients in protocol 2) were included in the study. The mean overall impression score for computer-generated EHRs was higher versus physician EHRs (4.2 vs. 2.6; p < .001). Our study demonstrated that EHRs created by physicians' exhibit inaccuracies or deficiencies in various pieces of information. In the second protocol, in which the AACE form was presented to the physician before the examination, it was determined that the examination time was shorter, the number of tests requested, and the number of new drugs prescribed were less. We observed that the patient-provider portal, systematically collecting symptom and clinical data from patients through a computer algorithm known as AACE, yielded records that were of higher quality, more comprehensive, better organized, and more relevant compared to those documented by physicians.

“Death threats and despair”: A conceptual model delineating moral distress experienced by pediatric gender-affirming care providers

Gender-Affirming Care Providers (GACPs) for children and adolescents function within an intricate socio-political landscape that necessitates navigating legislative restrictions, institutional betrayals, and overarching societal prejudices. This manuscript presents a conceptual model that captures the multifaceted factors inducing moral distress among these professionals, including social workers, counselors, nurses, and physicians. Employing a system dynamics lens, our model delineates the complex interplay of legislative, societal, and institutional pressures with individual experiences, coping mechanisms, and resilience-building endeavors. While underscoring the pronounced challenges confronting pediatric GACPs—ranging from societal oversight to the long-term implications of decisions made during adolescence—we also highlight the pivotal role of identity concordance in enhancing patient-provider interactions. Shared identities between transgender and gender-diverse patients and providers can act as catalysts for fostering trust, bridging communication gaps, and serving as affirming representations of societal acceptance and success. Based on these insights, we offer robust recommendations including comprehensive institutional training, technological safeguards against online harassment, community alliances for multifaceted support, and intensified nationwide advocacy campaigns emphasizing the evidence-based nature of gender-affirming care. Through this comprehensive exploration, our aim extends beyond merely outlining challenges; we spotlight potent avenues for intervention, positive change, and reinforced support structures for GACPs. In sum, this paper contributes a profound understanding of the dynamics influencing GACPs, offering a clarion call for proactive measures to support these professionals and their patients in today's challenging socio-political environment.

Pharmacological Prescribing and Satisfaction with Pain Treatment Among Non-Hispanic Black Men with Chronic Pain.

Pharmacological strategies are often central to chronic pain management; however, pain treatment among non-Hispanic Black men may differ because of their disease profiles and healthcare interactions. However, less is known about pain medication prescribing and patients' satisfaction with pain treatment and management among non-Hispanic Black men with self-reported chronic pain. This study assessed factors associated with non-Hispanic Black men being prescribed/recommended narcotics/opioids for chronic pain and their satisfaction with pain treatment/management. Data were analyzed from 286 non-Hispanic Black men with chronic pain who completed an internet-delivered questionnaire. Participants were recruited nationwide using a Qualtrics web-based panel. Logistic regression was used to identify factors associated with being prescribed/recommended narcotics/opioids for pain management treatment. Then, ordinary least squares regression was used to identify factors associated with their satisfaction level with the pain treatment/management received. On average, participants were 56.2 years old and 48.3% were prescribed/recommended narcotics/opioids for chronic pain. Men with more chronic conditions (Odds Ratio [OR] = 0.57, P = 0.043) and depression/anxiety disorders (OR = 0.53, P = 0.029) were less likely to be prescribed/recommended narcotics/opioids. Men who were more educated (OR = 2.09, P = 0.044), reported more frequent chronic pain (OR = 1.28, P = 0.007), and were allowed to participate more in decisions about their pain treatment/management (OR = 1.11, P = 0.029) were more likely to be prescribed/recommended narcotics/opioids. On average, men with more frequent chronic pain (B = -0.25, P = 0.015) and pain problems (B = -0.16, P = 0.009) were less satisfied with their pain treatment/management. Men who were allowed to participate more in decisions about their pain treatment/management reported higher satisfaction with their pain treatment/management (B = 0.55, P < 0.001). Playing an active role in pain management can improve non-Hispanic Black men's satisfaction with pain treatment/management. This study illustrates the importance of patient-centered approaches and inclusive patient-provider interactions to improve chronic pain management.

The impact of telemedicine on cardiac patient outcomes: A study in Saudi Arabian hospitals

&lt;sec&gt;&lt;title&gt;Introduction&lt;/title&gt;&lt;p&gt;Telemedicine has been increasingly integrated into cardiac care, thus offering remote monitoring and consultation for patients with cardiovascular diseases. It promises to improve patient outcomes, especially in heart failure management, by enabling continuous monitoring of vital signs and facilitating remote patient-provider interactions. This technology has gained particular significance amidst the COVID-19 pandemic, thereby offering a safer alternative to in-person visits. This study assesses the effectiveness of telemedicine in the management of cardiac patients in Saudi Arabia, and reflects on its benefits, challenges, and overall impact on patient outcomes.&lt;/p&gt;&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;Methods&lt;/title&gt;&lt;p&gt;A retrospective cohort study was conducted to analyze patient records from Saudi healthcare facilities and compare health indicators before and after telemedicine implementation. The study involved cardiac patients who received telemedicine consultations and a control group who received traditional care. Statistical analyses, including the chi-square test, t-test, and ANOVA, were performed to identify differences between the groups while controlling for confounders.&lt;/p&gt;&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;Results&lt;/title&gt;&lt;p&gt;There were no statistically significant differences between the telemedicine and control groups in terms of blood pressure (P = 0.72), heart rate (P = 0.65), readmission rate (P = 0.54), and medication adherence (P = 0.48). The patient satisfaction was slightly higher in the telemedicine group, although the difference was not statistically significant (mean satisfaction score of 3.01 vs. 2.83, P = 0.41).&lt;/p&gt;&lt;/sec&gt;&lt;sec&gt;&lt;title&gt;Conclusions&lt;/title&gt;&lt;p&gt;The introduction of telemedicine did not significantly alter the cardiac patient outcomes compared with traditional in-person care in Saudi Arabia. Although telemedicine offers a promising alternative for patient management, its effectiveness may vary based on the individual patient's needs and specific health indicators. Further research is necessary to explore its full potential and to optimize its application in cardiac care.&lt;/p&gt;&lt;/sec&gt;

Barriers and Facilitators during Community Reintegration of People with Spinal Cord Injury: A Qualitative Study.

Spinal cord injury (SCI) individuals face challenges in community reintegration due to various factors. This study explores the barriers and facilitators affecting their reintegration, aiming to understand and address their diverse needs and challenges in different cultural contexts. The present qualitative study was conducted between December 2021 to June 2022 among 71 SCI individuals as data saturation was achieved. Data was collected via structured in-depth interview. Participants were identified through purposive sampling method, admitted, or visited to rehabilitation center, India. Data was analyzed according to Braun and Clarke's thematic analysis method using MAXQDA 2020. Data analysis led to the emergence of four major themes and several sub-themes specific to the single problem domain. The four major themes of barriers included environmental, cultural, psychological and health-related barriers. However, four facilitators (Family support, financial stability, religious practices, friends and leisure activity) came up which may help in overcoming from the challenges faced by the SCI individuals. People with SCI face various problems in their care, management and social lives. It is important to give attention to their needs along with comprehensive health support and strengthen the patient-provider interaction. This may generate a sense of self efficacy, self-esteem and promotes the mental well-being of people with spinal cord injuries. Working on the above mentioned issues can help SCI people in low- and middle-income countries become more integrated into their communities.

Abstract B052: Associations of cancer patients' sociodemographic characteristics with cannabis-related behaviors

Abstract Background: Medical and non-medical cannabis is increasingly legalized and popularized in the US, yet there is a paucity of research on the subject, particularly in a cancer context. Previous research examining correlates of sociodemographic characteristics with cannabis-related behaviors are limited to gender-specific comparisons. In the present study, we examined how these behaviors by adults with cancer differed by age, gender, race, educational attainment, and cancer type. Methods: 943 patients attending any of 8 Ohio State University Comprehensive Cancer Center clinics were recruited in person (n=721) or remotely (n=222) into an anonymous cross-sectional study. Eligible patients were ≥18 years of age and were diagnosed with invasive cancer (all stages) in the past 12 months. Participants self-administered a validated, extensive cannabis-focused questionnaire, which queried on cannabis-related behaviors and use, along with demographic and clinical information. Descriptive statistics, chi-square tests, and multivariable logistic regressions were used to examine associations between cannabis-related behaviors and sociodemographic factors and cancer type. Results: Participants were, on average, 61.7 ± 12.1 years old with at least some college education (70.4%). Older participants, aged ≥ 63 years, were less likely to be currently using cannabis (OR=0.27, 95% CI: 0.17-0.43; P&amp;lt;0.001) and less likely to be interested in cannabis (OR=0.60, 95% CI: 0.43-0.82; P=0.001) than younger participants. Participants with at least a 4-year college degree were less likely to be currently using cannabis (OR=0.48, 95% CI: 0.28-0.84, P=0.009) and less likely to have received a provider recommendation of cannabis use compared to the least educated (OR=0.31, 95% CI: 0.14-0.72, P=0.006). Patients with skin cancer were less likely to be currently using cannabis compared to those with lung cancer (OR=0.26, 95% CI: 0.07-0.92; P=0.037). Conclusions: Multiple factors (e.g., age, educational attainment) were associated with differences in cannabis-related behaviors among cancer patients. Results indicate that differences by sociodemographic characteristics exist, which may be associated with differences in symptom burden, patient-provider interactions, and other health behaviors. These results add to a burgeoning area of research and provide insight for future research and clinical inquiry related to cannabis use among cancer patients. Citation Format: Neema C. Adley, Jessica L. Krok-Schoen, Theodore M. Brasky, Jesse J. Plascak, Alison M. Newton, Anita Adib. Associations of cancer patients' sociodemographic characteristics with cannabis-related behaviors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B052.

Communicating the Crisis: Navigating the Challenges of Chemotherapeutic Drug Shortages with a Patient-Centered Ethical Dialogue Framework

Introduction: The United States finds itself gripped by debilitating drug shortages, thrusting thousands of patients nationwide into a precarious limbo and making the potential delay or cancellation of essential chemotherapy treatments a reality. In June 2023, the situation escalated to encompass a staggering 309 active drug shortages, including twenty-five chemotherapeutics, two of which are carboplatin and cisplatin. Communicating the nuances of a chemotherapy drug shortage to those affected transforms into a multifaceted and delicate endeavor that demands deep-seated empathy, preparation, and understanding. Mastering strategic, patient-centered communication becomes an ethical imperative and valuable skill for all physicians, amplifying the human connection at the heart of medicine. Our multidisciplinary team of specialists developed an ethical communication framework to guide physicians in navigating and discussing the complexities of modern drug shortages with patients. This framework promotes empathetic and informative dialogue with patients, empowering them to understand the situation and actively participate in their care decisions. Through this approach, we aim to foster a partnership between physicians and patients, mitigating anxieties and ensuring patients feel heard and supported throughout this trying period. Method: A multidisciplinary team of specialists convened, including physicians, advanced practice providers from hematology and oncology, and bioethicists. We developed an ethical and theoretical communication framework that will prove beneficial for both physicians and patients. Our framework facilitates compassionate and informed exchanges between healthcare professionals and their patients. Special care was given to consider the patient's background, perspectives, and beliefs. Results: The ethical communication framework for addressing chemotherapeutic shortages demonstrated promising potential for enhancing patient-provider interactions during times of crisis. The framework emphasizes open and transparent communication, facilitating patient understanding of the drug shortage situation and empowering patients to participate in their treatment actively. Conclusion: The developed ethical communication framework offers a patient-centered approach to addressing this crisis, aiming to empower patients with knowledge and understanding while fostering a collaborative decision-making process during crisis communication. By prioritizing empathy, transparency, and patient autonomy, the framework serves as a valuable tool for navigating the complexities of drug shortages and mitigating patient fears when discussing the drug shortage crisis. As the framework continues to be integrated into healthcare systems, ongoing evaluation and tracking of patient outcomes will provide valuable insights into its effectiveness and potential areas for improvement in communicating the crisis. Through strategic and empathetic patient-centered communication, physicians can play a crucial role in supporting patients during the national drug shortage crisis, ensuring that patients' voices are heard and their needs are addressed with compassion and understanding when communicating the crisis.

Factors affecting adherence to psychotropics in trauma-affected refugees: data from a randomized controlled trial

Non-adherence to psychotropic drugs may reduce treatment effectiveness and may cause exacerbation of illness. Among migrant populations, studies have identified low adherence to psychotropic drugs. This study aimed to identify factors that were associated with the three basic components of adherence: non-initiation, non-implementation (blood sample), and discontinuation in a clinical sample of trauma-affected refugees diagnosed with posttraumatic stress disorder. The data for this study is derived from a randomized controlled trial (n = 108). Based on existing literature, individual sociodemographic and clinical candidate predictor variables that may affect the initiation, continuation, and implementation to psychotropics were selected as exposure variables. Logistic regression was used to assess the risk relation between non-initiation, non-implementation, discontinuation, and the individual sociodemographic and clinical factors. Three factors – level of education, turn-up rate for medical doctor sessions, and discomfort in relation to the psychotropics – were associated with non-initiation, non-implementation, or discontinuation. The relatively small sample size poses a limitation. Furthermore, factors not examined in the current study may have affected non-initiation, non-implementation, and discontinuation. The study identified level of education, turn-up rate for medical doctor sessions, and discomfort in relation to medicine as important factors in relation to treatment with psychotropics in trauma-affected refugees. Factors contributing to a low turn-up rate, and factors that are consequences of a low turn-up rate, as well as communication and trust in the patient-provider interaction need further research attention. Furthermore, there is a need for research on interventions addressing adherence for refugees with mental illness.

Exploring Delivery of Adolescent Preventive Health Services During the COVID-19 Pandemic: Perceptions and Experiences Shared by Healthcare Professionals

Abstract Background While unmitigated vaccine hesitancy was already growing before the emergence of COVID-19, the global pandemic has introduced additional challenges to the immunization sector. Despite the benefits, routine preventive care was forestalled by challenges related to pandemic lockdowns/quarantine, parental reluctance to seek preventative services, poor access to healthcare, loss of income and/or health insurance, and the inability of children under 12 to be immunized against the coronavirus. Considering the potential impacts caused by the pandemic’s disruption of adolescent preventative care services, we explored the experiences of adolescent healthcare providers in Tennessee and Georgia in providing care throughout the COVID-19 pandemic. Methods A series of in-depth qualitative interviews were conducted between December 2020 and May 2021 via the video conferencing platform, Zoom, among a diverse group of adolescent healthcare providers (n=16) representing 5 healthcare practices located within the southeastern states of Georgia and Tennessee. Audio recordings were transcribed verbatim and analyzed using a rapid qualitative analysis framework, guided by the grounded theory and inductive approach. Results Preventive adolescent services were adversely impacted by the COVID-19 pandemic at all participating practices. Participants highlighted an initial decrease in patients due to the pandemic, despite the implementation of protective measures such as an increase in sanitation measures, hand washing, separation of sick and wellness visits, mask mandates, and telehealth/video conferencing opportunities. While practices continued to distribute educational materials, many removed material from their waiting rooms due to sanitary concerns related to COVID-19. Participants reported that patient-provider communications; effective use of presumptive languaging; periodic reminders/recall messages; provider’s personal recommendation on vaccine safety/efficacy; early initiation of human papillomavirus (HPV) vaccination series at 9 years; community partnerships with health navigators/vaccine champions/vaccine advocates; use of standardized forms/prewritten scripts/standard operating protocols for patient-provider interactions; and vaccine promotion through social media, brochures/posters/pamphlets, as well as outreach to schools and churches, served as facilitators to adolescent HPV vaccine uptake. Conclusions By exploring the perceptions and experiences of adolescent healthcare providers, our research identified key factors influencing adolescent vaccination uptake and its relatedness to the COVID-19 pandemic. We argue our findings support and encourage the development of personalized patient-provider communications, trusting relationships, effective use of presumptive languaging, and counteraction of misinformation as solutions to suboptimal preventative services and vaccination coverage rates. Implementation of these comprehensive strategies could not only ameliorate routine adolescent vaccination uptake but could also aid in the expansion of COVID-19 vaccine acceptance on a sizable scale.

Testing interventions to reduce clinical inertia in the treatment of hypertension: rationale and design of a pragmatic randomized controlled trial

Clinical inertia, or failure to intensify treatment when indicated, leads to suboptimal blood pressure control. Interventions to overcome inertia and increase antihypertensive prescribing have been modestly successful in part because their effectiveness varies based on characteristics of the provider, the patient, or the provider-patient interaction. Understanding for whom each intervention is most effective could help target interventions and thus increase their impact. This three-arm, randomized trial tests the effectiveness of 2 interventions to reduce clinical inertia in hypertension prescribing compared to usual care. Forty five primary care providers (PCPs) caring for patients with hypertension in need of treatment intensification completed baseline surveys that assessed behavioral traits and were randomized to one of three arms: 1) Pharmacist e-consult, in which a clinical pharmacist provided patient-specific recommendations for hypertension medication management to PCPs in advance of upcoming visits, 2) Social norming dashboards that displayed PCP's hypertension control rates compared to those of their peers, or 3) Usual care (no intervention). The primary outcome was the rate of intensification of hypertension treatment. We will compare this outcome between study arms and then evaluate the association between characteristics of providers, patients, their clinical interactions, and intervention responsiveness. Forty-five primary care providers were enrolled and randomized: 16 providers and 173 patients in the social norming dashboards arm, 15 providers and 143 patients in the pharmacist e-consult arm, and 14 providers and 150 patients in the usual care arm. On average, the mean patient age was 64 years, 47% were female, and 73% were white. Baseline demographic and clinical characteristics of patients were similar across arms, with the exception of more Hispanic patients in the usual care arm and fewest in the pharmacist e-consult arm. This study can help identify interventions to reduce inertia in hypertension care and potentially identify the characteristics of patients, providers, or patient-provider interactions to understand for whom each intervention would be most beneficial. Clinicaltrials.gov (NCT, Registered: NCT04603560).

Healthcare provider experiences interacting with survivors of intimate partner violence: a qualitative study to inform survivor-centered approaches

BackgroundIntimate partner violence (IPV) remains a pervasive form of gender-based violence (GBV) that is largely undisclosed, especially among women seeking healthcare services in Uganda. Prioritizing survivor needs may improve IPV disclosure. This study explores healthcare worker experiences from provider-patient interactions with survivors seeking antenatal care services (ANC) in Uganda.MethodsIn-depth interviews were conducted among twenty-eight experienced healthcare providers in a rural and an urban-based ANC clinic in Eastern and Central Uganda. Providers were asked what they viewed as the needs and fears of women identified as having experienced any form of IPV. Iterative, inductive/deductive thematic analysis was conducted to discover themes regarding perceived needs, fears, and normalizing violence experienced by IPV survivors.ResultsAccording to healthcare providers, IPV survivors are unaware of available support services, and have need for support services. Providers reported that some survivors were afraid of the consequences of IPV disclosure namely, community stigma, worries about personal and their children’s safety, retaliatory abuse, fear of losing their marriage, and partners’ financial support. Women survivors also blamed themselves for IPV. Contextual factors underlying survivor concerns included the socio-economic environment that ‘normalizes’ violence, namely, some cultural norms condoning violence, and survivors’ unawareness of their human rights due to self-blame and shame for abuse.ConclusionsWe underscore a need to empower IPV survivors by prioritizing their needs. Results highlight opportunities to create a responsive healthcare environment that fosters IPV disclosure while addressing survivors’ immediate medical and psychosocial needs, and safety concerns. Our findings will inform GBV prevention and response strategies that integrate survivor-centered approaches in Uganda.

Ontology of language, with applications to demographic data

Here we present what we believe is a novel account of what languages are, along with an axiomatically rich representation of languages and language-related data that is based on this account. We propose an account of languages as aggregates of dispositions distributed across aggregates of persons, and in doing so we address linguistic competences and the processes that realize them. This paves the way for representing additional types of language-related entities. Like demographic data of other sorts, data about languages may be of use to researchers in a number of areas, including biomedical research. Data on the languages used in clinical encounters are typically included in medical records, and capture an important factor in patient-provider interactions. Like many types of patient and demographic data, data on a person’s preferred and primary languages are organized in different ways by different systems. This can be a barrier to data integration. We believe that a robust framework for representing language in general and preferred and primary language in particular – which has been lacking in ontologies thus far – can promote more successful integration of language-related data from disparate data sources.

Understanding barriers to and facilitators of clinician-patient conversations about brain health and cognitive concerns in primary care: a systematic review and practical considerations for the clinician

BackgroundPrimary care clinicians (PCCs) are typically the first practitioners to detect cognitive impairment in their patients, including those with Alzheimer’s disease or related dementias (ADRD). However, conversations around cognitive changes can be challenging for patients, family members, and clinicians to initiate, with all groups reporting barriers to open dialogue. With the expanding array of evidence-based interventions for ADRD, from multidomain care management to novel biotherapeutics for early-stage AD, incorporating conversations about brain health into routine healthcare should become a standard of care. We conducted a systematic review to identify barriers to and facilitators of brain health conversations in primary care settings.MethodsWe systematically searched PubMed, Scopus, Web of Science, and the Cochrane Library for qualitative or quantitative studies conducted in the US between January 2000 and October 2022 that evaluated perceptions of cognition and provider-patient brain health conversations prior to formal screening for, or diagnosis of, mild cognitive impairment or ADRD. We assessed the quality of the included studies using the Mixed Methods Appraisal Tool.ResultsIn total, 5547 unique abstracts were screened and 22 articles describing 19 studies were included. The studies explored perceptions of cognition among laypersons or clinicians, or provider-patient interactions in the context of a patient’s cognitive concerns. We identified 4 main themes: (1) PCCs are hesitant to discuss brain health and cognitive concerns; (2) patients are hesitant to raise cognitive concerns; (3) evidence to guide clinicians in developing treatment plans that address cognitive decline is often poorly communicated; and (4) social and cultural context influence perceptions of brain health and cognition, and therefore affect clinical engagement.ConclusionsEarly conversations about brain health between PCCs and their patients are rare, and effective tools, processes, and strategies are needed to make these vital conversations routine.

Characteristics and Outcomes of Conditions Encountered in Primary Care During FIFA World Cup 2022 in Qatar - A Cross-Sectional Study

The FIFA World Cup, a massive football event, presents significant challenges to healthcare systems. Primary healthcare plays a crucial role in patient-provider interactions and serves as a cornerstone of the system. This study aimed to assess the frequency, characteristics, and outcomes of conditions treated in primary care facilities during the FIFA World Cup Qatar 2022. A cross-sectional study was conducted from November 15 to December 20, 2022. All patients visiting the 29 governmental primary healthcare facilities in Qatar were included. Anonymous patient data, including age, sex, nationality, diagnosis, treatments, visit date, consultation type, and outcomes, were extracted from electronic medical records. A total of 401,962 patients were seen in primary care, with an average age of 34.50 ±19.3 years. Less than 1% held Hayya Visa (n=3120, 0.8%), and roughly 2% were referred to secondary care (8494, 2.1%). The most prevalent diagnoses were Type 2 diabetes mellitus (n=59670, 7.7%) and upper respiratory tract infection (n=47364, 6.2%). Paracetamol was the most frequently prescribed medication (n=69,960, 11.9%). Elderly patients (OR=1.23), non-Qatari patients (OR=1.25), and male patients (OR=1.17) were more likely to be referred to secondary care. Hayya cardholders were about twice as likely to be transferred (OR=2.40). Primary healthcare services operated efficiently during the FIFA World Cup 2022 in Qatar. The majority of cases involved managing chronic diseases and minor respiratory infections. Football enthusiasts and non-Qatari individuals were more often referred to secondary healthcare. These findings can guide policymakers in enhancing primary healthcare services for future mass gatherings.

Look and Listen: How the Coldness of Health Care Providers is Modifiable

Purpose: To explore how we can make Health Care Providers (HCP) more conscious of their gaze and to encourage HCPs to make more eye contact with their patients, making them better suited to promote meaningful lives for them, thus strengthening the patient-provider relationship. Methods: Mixed quantitative and qualitative descriptive experimental design with narrative data analysis. 40 participants (23 HCPs and 17 chronic pain patients) viewed standardized videos depicting a patient-provider interaction in which the HCP did not look at the patient. Self-assessments and reflections were obtained. Results: Most HCPs recognized the clinical approach in the videos as cold, whereas 41% of patients recognized it as “normal”. When looking into patient’s eyes, 44% of HCPs were unable to identify the patients’ emotions, nor their own feelings. Powerlessness and vulnerability were emotions often felt by the HCP. Patients and HCPs agree that better addressing meaningful activities in a patient’s life, as well as looking at the patient more, would positively impact patient outcomes and pain management. At the one-month follow-up, 74% of HCPs had increased the amount of eye-contact made during their encounters and paid more attention to the relational aspect of their care. Conclusion: We succeeded in making HCPs more aware of the gaze they hold onto their patients, thus encouraging them to change their actions. We attributed the lack of eye contact and lack of focus on meaningful activities to a sense of vulnerability felt by HCPs. We believe that non-verbal communications skills should be more overtly taught in medical school.

Shared decision-making in a medicalized birth environment: mixed-methods exploratory study, Cyprus

Abstract Background Maternity care practices are not always supportive of participation in decision-making; a fundamental pillar of the WHO Respectful Maternity Care framework. With the highest caesarean section (C/S) rate in the EU (&amp;gt;60%), high episiotomy rates (70.9%) etc, the medicalised birth environment in Cyprus raises questions about Informed Choice. Methods Following focus groups (N = 12) with pregnant women and new mums (N = 62), an online survey was shared via the Baby Buddy Cyprus webapp. Women responded to the Maternal Autonomy in Decision-Making (MADM) scale along a battery of scales, including perceived efficacy in patient-provider interaction (PEPPI) and Kim Alliance Scale (KAS). Results Based on MADM classification, 54.3% of 387 participants (64% primiparas, 42% C/S, 80% private sector) were classified as having high autonomy, while one in five were classified as low or very low. There were lower scores among primiparous women (p = 0.02) and higher among those receiving care in the private sector (p &amp;lt; 0.001). Perceived efficacy in interaction was related to educational attainment (p-value for trend=0.02). In regression models, KAS (b coeff= 1.25 95%CI 1.06, .1.45; p &amp;lt; 0.001) and PEPPI (b coeff = 0.38 95%CI 0.24, 0.52; p &amp;lt; 0.001) were independently associated with MADM after adjusting for socio-demographic and pregnancy characteristics. Consistently, having a “confident voice” in an ‘unsupportive system’ where the ‘art of communication’ is often left to the women themselves emerged as themes from the qualitative study. Conclusions Participation in decision-making among pregnant women in Cyprus is problematic. Given that reduction of C/S, most classified as elective by maternal request, was identified as national Public Health priority, further research is necessary. Continuous professional training along with population-level interventions to promote self-agency may be needed, especially since childbirth rights were further compromised during the COVID-19 pandemic. Key messages • Against physician dominance in communication, birthing women in Cyprus do not rate participation in decision-making favourably. • Further research is needed around Informed Choice, including educational and population-level interventions targeted at healthcare providers as well as women.

Health care workers' perceptions and bias toward men as HIV clients in Malawi and Mozambique: A qualitative study.

Men are underrepresented in HIV services throughout sub-Saharan Africa. Little is known about health care worker (HCW) perceptions of men as clients, which may directly affect the quality of care provided, and HCWs' buy-in for male-specific interventions. Focus group discussions (FGDs) were conducted in 2016 with HCWs from 15 facilities across Malawi and Mozambique and were originally conducted to evaluate barriers to universal treatment (not HCW bias). FGDs were conducted in local languages, recorded, translated to English, and transcribed. For this study, we focused on HCW perceptions of men as HIV clients and any explicit bias against men, using inductive and deductive coding in Atlas.ti v.8, and analyzed using constant comparison methods. 20 FGDs with 154 HCWs working in HIV treatment clinics were included. Median age was 30 years, 59% were female, and 43% were providers versus support staff. HCWs held strong explicit bias against men as clients. Most HCWs believed men could easily navigate HIV services due to their elevated position within society, regardless of facility-level barriers faced. Men were described in pejorative terms as ill-informed and difficult clients who were absent from health systems. Men were largely seen as "bad clients" due to assumptions about men's 'selfish' and 'prideful' nature, resulting in little HCW sympathy for men's poor use of care. Our study highlights a strong explicit bias against men as HIV clients, even when gender and bias were not the focus of data collection. As a result, HCWs may have little motivation to implement male-specific interventions or improve provider-patient interactions with men. Framing men as problematic places undue responsibility on individual men while minimizing institutional barriers that uniquely affect them. Bias in local, national, and global discourses about men must be immediately addressed.