Patient Perceptions Research Articles

Utilising Adaptive Choice-Based Conjoint Approach to Facilitate Shared Decision-Making in Osteoarthritis Management: A Patient Perception Study.

This study examines the application of the adaptive choice-based conjoint (ACBC) method to facilitate the shared decision-making (SDM) process for osteoarthritis (OA) treatment. The study recruited adult OA patients attending the rheumatology/orthopaedics clinics in a local urban hospital in Abu Dhabi, United Arab Emirates (UAE). Participants completed a questionnaire regarding who influences their decision in selecting OA medication, followed by an ACBC questionnaire about OA medication preferences and a questionnaire about the potential contribution of ACBC to the SDM process. A univariate analysis was used to investigate the relationships between participant variables and factors that influence their decision-making processes. The chi-squared, Fisher's exact, Cramer's V coefficient test and multivariable logistic regression analysis were utilised. The primary outcome investigates the contribution of the ACBC method to the SDM process for OA treatment. Secondary outcomes measure the association between patient demographics and variables related to the SDM process and ACBC questionnaire. Five hundred patients participated in this study, with a response rate (RR) of 100%. Most study participants were 60-69 years old (34.8%), females (78.8%), and UAE nationals (90.4%). Patients' opinions and online/paper information influencing their decision in selecting OA medication had a statistically significant association with age, gender, education, and employment (P=0.001 - 0.039). Employment status showed the strongest association (φc=0.170) with being independent in making the decision about OA medications, while education levels showed the strongest association (φc=0.24) with decisions impacted by online/paper information. The results of the multivariable logistic analysis showed that the only statistically significant variable for online/paper information that influenced the decision in selecting OA medication was education level (p=0.003). Most participants agreed or strongly agreed that the ACBC predicted their preferences for OA treatment (96.8%), the questionnaire may help doctors understand patients' preferences (93%) and recommended the use of ACBC tool doctors' clinics to aid the SDM process (92.8%) between patients and their physicians. ACBC approach can facilitate doctors' understanding of patients' preferences and aid the SDM process. Most OA patients are independent or influenced by their physician when making decisions about OA medication. Higher education and employment among OA patients are associated with a better involvement in the SDM process for available treatment.

DESAFIOS NA ADESÃO MEDICAMENTOSA SOB A PERSPECTIVA DOS PROFISSIONAIS DE SAÚDE DA ATENÇÃO PRIMÁRIA

This study explores the factors influencing medication adherence among patients of the Family Health Strategy (ESF) in Embu das Artes/SP, based on the perspectives of healthcare professionals. The qualitative research, which involved semi-structured interviews and a literature review, identified low health literacy among patients as the primary barrier. Adherence to treatment is influenced by internal factors, such as patient perception and motivation, as well as external factors, including socioeconomic status and cultural aspects. The lack of understanding regarding the importance of medications and the chronic nature of diseases exacerbates the problem, leading to elevated risks such as mortality and hospital readmission. Professionals reported challenges such as fear of side effects and confusion over medication schedules. These issues underscore the need to enhance healthcare professionals' training to develop educational strategies aimed at providing health literacy and achieving more effective treatment adherence.

Correlations among quality of life, spinal mobility, and disease activity in early-treated axial spondyloarthritis: a single-center cross-sectional study

BackgroundAxial spondyloarthritis (axSpA) significantly impacts patients’ lives. The ASAS-OMERACT guideline was formulated for the multidimensional evaluation of axSpA patients, employing a specific set of tools. Given the pivotal role of patient perception, comprehensive correlation among these tools, especially concerning quality of life, may provide a clinically relevant perspective and enhance treatment efficacy in the early stages of the disease. This study aims to investigate the correlation among disease activity, functional ability, and quality of life in early-treated axSpA patients. In addition, the association between high disease activity and clinical characteristics was explored.MethodsThis cross-sectional study was conducted in a tertiary hospital in Thailand. Patients diagnosed with axSpA according to ASAS classification criteria and receiving treatment from rheumatologists within three years of onset of symptoms were included. Clinical and laboratory data were retrieved from a hospital database. Disease activity was assessed using the Ankylosing Spondylitis Disease Activity Score with ESR or CRP (ASDAS-ESR/CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Spinal mobility was measured using the Bath Ankylosing Spondylitis Metrology Index (BASMI), while quality of life and function were evaluated using the ASAS Health Index (ASAS-HI) and Bath Ankylosing Spondylitis Functional Index (BASFI), respectively. The correlation between these measurements was analyzed using the Pearson correlation coefficient (r). Additionally, factors associated with high disease activity (ASDAS/CRP > 2.1) were explored using multivariate regression analysis.ResultsSixty-six patients (41 males; mean age 49.3 ± 13.3 years) were enrolled between April to December 2022. Disease activity (ASDAS-CRP) was significantly inversely correlated with spinal mobility (BASMI), function (BASFI), and quality of life (ASAS-HI). High disease activity was associated with obesity (BMI ≥ 30 kg/m^2) and a longer duration of symptoms before treatment (≥ 2 years).ConclusionIn early-treated axSpA patients, ASDAS-CRP showed significant correlations with functional ability, quality of life, and spinal mobility. High disease activity was associated with obesity and a longer pre-treatment symptom duration in our study. Early treatment may enhance patients’ function, mobility, and quality of life, with weight reduction being possibly beneficial for obese axSpA patients.Clinical trial numberNot applicable.

The patient’s perspectives of safe and routine proactive deprescribing in primary care for older people living with polypharmacy: a qualitative study

BackgroundThe process of identifying and discontinuing medicines in instances in which harms outweigh benefits (deprescribing) can mitigate the negative consequences of problematic polypharmacy. This process should be conducted with a focus on the patient and involve collaborative decision-making. Evidence is needed regarding patients’ views on how deprescribing should be safely and routinely implemented in English primary care to improve its application. This study aimed to identify optimal methods of introducing and actioning deprescribing from the patient’s perspective.MethodsParticipants in England aged 65 and above who were taking five or more medicines and residing in their own homes were recruited through social media and service user groups. An interview guide was created from deprescribing literature and input from patients and the public, guided by the Normalisation Process Theory (NPT). The interviews were held online using Microsoft Teams® or via phone, recorded, and then transcribed. The data was analysed using the Framework analysis.ResultsTwenty patients (mean age of 74.5, SD = 6.93), with 75% being female, were enrolled in the study. Three main themes emerged: (1) ‘Why deprescribe now?’ emphasised the significance of explaining the reasons behind deprescribing; (2) ‘Monitoring and follow-up’ underscored the necessity of safety measures during deprescribing and patients’ willingness to self-monitor post-intervention; (3) ‘Roles and relationships’ explored patient perceptions of various healthcare professionals involved in deprescribing and the essential interpersonal skills for fostering therapeutic relationships.ConclusionOptimal methods of introducing deprescribing included communicating a convincing rationale for stopping medicines and preparing patients for deprescribing conversations. Patients required support from a range of healthcare professionals with whom they had an existing therapeutic relationship. Whilst patients were motivated to self-monitor unwanted/unexpected effects post-deprescribing, timely support was required. The nature of such bolstered collective action and cognitive participation within NPT enhances the normalisation potential of deprescribing. These findings highlight the significance of considering the content and process of deprescribing consultations to enhance normalisation and tackle problematic polypharmacy. This provides a deeper understanding of patients’ needs for implementing safe and routine deprescribing in primary care, which should be considered when designing medication review and deprescribing services.

EVALUATING GLIOMA PATIENT PERCEPTIONS TOWARDS REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION FOR REHABILITATION

Abstract AIMS Repetitive Transcranial Magnetic Stimulation (rTMS) is established for depression, chronic pain, and motor rehabilitation after stroke. It is an emerging tool for other purposes including cognitive rehabilitation. Recent evidence supports its use for motor rehabilitation after brain surgery. We sought to evaluate patient perceptions towards rTMS. METHOD Two studies were undertaken. Group 1 – patients who received seven days of rTMS for motor rehabilitation for post-operative weakness (MRC 0-1 in any limb) following resection of a glioma or other resective pathology were prospectively surveyed on the last day of their rTMS treatment, as well as their next of kin (NOK). Group 2 – patients who had previously been treated for a glioma but did not receive rTMS were retrospectively surveyed through two brain tumour charities, as well as their NOK. RESULTS Group1: 21 responses. 11 patients, 10 NOK. Commonest pathology was glioblastoma(n=3). Group2: 24 responses. 16 patients, 8 NOK. Commonest pathology was grade 2 glioma(n=7). Most Group1 respondents reported a positive experience with rTMS(n=15). Group1 patients experienced substantial subjective improvements in motor functioning(n=6), some improvements(n=3), or no change(n=2). None reported worsening. Experiencing adverse symptoms (e.g. headache) was associated with reduced likelihood of motor improvements(p=0.01). Most improvements were in gross rather than finer motor domains. Patients in Group2 were accepting of longer and more frequent rTMS sessions than Group1(p=0.03 and p=0.01 respectively). The commonest concerns raised pertained to seizures, side effects, and geographic availability. The commonest hope raised pertained to cognitive or motor improvements. CONCLUSION rTMS is well-tolerated and patients and their NOK support its use. Respondents would find longer and more sessions acceptable. Understandably, there is less tolerance for rTMS in the early post-operative period. However, enthusiasm for rTMS is substantial in the later stable post-operative phases. Our findings support the further development of rTMS as a tool for improving patient rehabilitation.

An Alternative Approach for Treating Female Underactive Bladders with Chronic Urine Retention: A Pilot Study on Combined Transvaginal Ultrasound-Guided Botulinum Toxin A External Sphincter Injection and Transurethral Incision of the Bladder Neck.

Background: Treating an underactive bladder (UAB) is challenging. Previously, we introduced a more precise method of transvaginal ultrasound-guided botulinum toxin A (BoNT-A) injection into the external urethral sphincter as a treatment option for patients with UABs. Although many patients experience good results, those with an UAB and excessive residual urine still require catheterization. Therefore, we developed a new method that combines transvaginal ultrasound-guided BoNT-A injection with a transurethral bladder neck incision. Methods: A prospective study was conducted on 16 patients who experienced symptoms of UAB and chronic urine retention. The treatment consisted of a combination of transvaginal ultrasound-guided BoNT-A injection and a transurethral incision of the bladder neck (TUI-BN). The primary objective was to assess the efficacy of this combined treatment in improving symptoms in women with UABs. Results: Our study demonstrated significant improvements after treatment, including increased voiding volume, decreased post-void residual (PVR) urine, and improved voiding efficiency. The frequency of clean intermittent catheterization (CIC) decreased at 1 and 3 months post-surgery, along with improvements in the AUA symptoms score and the Patient Perception of Bladder Condition (PPBC) score. Conclusions: Our study showed significant improvements in the surgical treatment of UABs using a combination of transvaginal ultrasound-guided BoNT-A and TUI-BN.

Exploring the Factors Associated with Sleep Concerns and Perceived Need for Treatment among Patients with Sleep Disorders

ABSTRACT Objectives This study aimed to investigate the factors affecting patient perceptions of sleep concerns and the need for treatment to understand and enable effective management. Methods This cross-sectional study analyzed data collected between November 2018 and October 2022 at the sleep clinic of a tertiary hospital. Adults aged > 19 years who completed sleep questionnaires and polysomnography (PSG) were included. Logistic regression models were used to assess the associations between demographic, clinical, and social factors, sleep questionnaire responses, and PSG data with self-reported sleep concerns (n = 3,457) and perceived need for treatment(n = 3,135). Results Insomnia-related symptoms affect both sleep concerns and need for treatment, and sleep maintenance is the most influential factor in both sleep concerns (odds ratio[OR] = 19.74, 95% confidence interval[CI] 6.17–63.20) and need for treatment (OR = 3.84, 95% CI 2.19–6.73). Young age (OR = 2.66, 95% CI 1.38–5.12), employment status, and daily life dysfunction were determinants of treatment readiness. None of the PSG parameters showed an independent association with sleep concerns or need for treatment. Conclusions Sleep maintenance problems had the most profound effect on sleep concerns and the need for treatment. Social needs are key factors in seeking treatment. A discrepancy has been noted between the effects of subjective and objective factors on sleep concerns and the need for treatment; therefore, patient management should pay attention to subjective sleep complaints.

"This Is Me" an Awareness-Raising and Anti-Stigma Program for Undergraduate Nursing Students: A Pre-Post Intervention Study.

Stigma education for nursing students has focused solely on stigma reduction, with studies showing temporary improvements in attitudes. However, nursing education research should also emphasize the importance of critical reflection and self-reflection to enhance attitudes, beliefs, topic comprehension, and learning satisfaction. This study aimed to evaluate the effectiveness of the "This is me" intervention regarding knowledge, attitudes, and communication skills of senior undergraduate nursing students in responding to mental illness-related stigma. This study employed a psychoeducational intervention for reducing mental illness stigma, using a questionnaire survey to assess pre- and post-intervention effects, with 37 eligible nursing students undergoing clinical training in psychiatric services between 16 May and 15 July 2022. Instruments included sociodemographic and health questions, the MICA-4 scale to evaluate students' attitudes toward mental illness, the MAKS to measure mental health knowledge, the Empathy Scale (JSPE-S), the Intergroup Anxiety Scale (SS-12), and the Attribution Questionnaire (AQ-27). Most students were female (73.0%) and single (70.3%), with a mean age of around 29 years. After implementing the psychoeducational program, there was a statistically significant increase in overall stigma-related knowledge (MAKS: Z = -1.99, p < 0.05), a decrease in intergroup anxiety (IAS: Z = -3.42, p < 0.05), and reductions in the perceptions of patients as dangerous (AQ27-Dangerousness: Z = -2.399, p < 0.05) and fear (AQ27-Fear: Z = -2.415, p < 0.05). Additionally, there was an improvement in empathy, specifically in Perspective Taking (JSPE: Z = -2.555, p < 0.05). This program may contribute to mental health literacy related to stigma, positively impacting therapeutic relationships and communication with people with mental illness and resulting in more effective care practices.

Patient perceptions of an electronic-health-record-based rheumatoid arthritis outcomes dashboard: a mixed-methods study

BackgroundOutcome measures are crucial to support a treat-to-target approach to rheumatoid arthritis (RA) care, yet their integration into clinical practice remains inconsistent. We developed an Electronic Heath Record-integrated, patient-facing side-car application to display RA outcomes (disease activity, functional status, pain scores), medications, and lab results during clinical visits (“RA PRO Dashboard”). The study aimed to evaluate patient perceptions and attitudes towards the implementation of a novel patient-facing dashboard during clinical visits using a mixed-methods approach.MethodsRA patients whose clinicians used the dashboard at least once during their clinical visit were invited to complete a survey regarding its usefulness in care. We also conducted semi-structured interviews with a subset of patients to assess their perceptions of the dashboard. The interviews were transcribed verbatim and analyzed thematically using deductive and inductive techniques. Emerging themes and subthemes were organized into four domains of the Ecological Model of Health.ResultsOut of 173 survey respondents, 79% were interested in seeing the dashboard again at a future visit, 71% felt it improved their understanding of their disease, and 65% believed it helped with decision-making about their RA care. Many patients reported that the dashboard helped them discuss their RA symptoms (76%) and medications (72%) with their clinician. Interviews with 29 RA patients revealed 10 key themes: the dashboard was perceived as a valuable visual tool that improved patients’ understanding of RA outcome measures, enhanced their involvement in care, and increased their trust in clinicians and the clinic. Common reported limitations included concerns about reliability of RA outcome questionnaires for some RA patients and inconsistent collection and explanation of these measures by clinicians.ConclusionsIn both the quantitative and qualitative components of the study, patients reported that the dashboard improved their understanding of their RA, enhanced patient-clinician communication, supported shared decision-making, and increased patient engagement in care. These findings support the use of dashboards or similar data visualization tools in RA care and can be used in future interventions to address challenges in data collection and patient education.

Areas for Improvement and Barriers Identified in Measuring the Quality of Nursing Care: Perceptions of Patients and Professionals.

Quality indicators in healthcare are essential to raising awareness about the appropriateness of nursing care. However, identifying the key indicators continues to pose a challenge, above all if one wants to include users and professionals. Identify which aspects of nursing care should be measured to assess the results of nursing care and how to do so. Interpretive qualitative exploratory study. The participants were users and professionals of an autonomous regional health service in Spain. The information was collected by means of two focus groups and eight semi-structured interviews conducted between November 2022 and March 2024. The data were analysed thematically using the Braun and Clarke process. The users and professionals agreed on the need to measure emotional skills and attitudes such as empathy, respect, and warmth when dealing with patients. The professionals highlighted workload and inefficiency of the current record system as barriers to adequately reflecting their work. They proposed improvements in the recording tool and the need for more human resources, as well as leadership that is more focused on quality. It is crucial to develop indicators that reflect both the emotional and technical aspects of nursing care. The participation by patients and professionals alike in this design and selection will make it possible to improve the quality of care and advances in the nursing profession. This study was not registered.

Health perceptions of patients with forgotten double-J stent.

In this article, we aimed to determine the health perceptions of the patients who did not apply for double-J stent (DJS) removal on time and evaluate whether health perceptions impact this behavior. Health perceptions of 22 patients who were treated for forgotten double-J stent (FDJS) between January 2017-October 2020 and 25 patients who applied for DJS removal during the given appointment time in the urology department of Elazig Training and Research Hospital and Elazig Fethi Sekin City Hospital were compared using the "Health Perception Scale". Health perception scale scores in the FDJS group and control group were 62-68 (mean = 64.27±1.75) and 63-68 (mean = 65.36±1.55), respectively. With regard to the sub-factors of the scale, control center scores were 21.86±0.77 and 22.08±1.15; precision scores were 16.54±0.80 and 16.56±0.82; importance of health scores were 12.77±0, 92 and 13.32±0.74; and self-awareness points were 13.04 ±0.72 and 13.48±0.58, respectively. There was a statistically significant difference between the health perception scale in total, importance of health, and self-awareness scores between the two groups. At the same time, there was no difference in terms of the control center and precision scores (p∗=0.029, p∗=0.030, p∗=0.028, p=0.460, p=0.951). Patients' and their families' educational status, income levels and lack of follow-up by healthcare professionals play an important role in forgotten DJS cases and patients' perception of health may also have an impact on this behavior.

Public deliberation to assess patient views on biosimilar medication switching for the treatment of inflammatory bowel disease

BackgroundBiosimilars are highly similar, but not identical, versions of originator biologic medications. Switching patients to biosimilars presents an opportunity to mitigate rising drug costs and expand patient access to important biologic therapies. However, decreased patient acceptance and adherence to biosimilar medications have been reported, which can lead to loss of treatment response, adverse reactions, and inefficient resource utilization. Understanding patient perceptions of biosimilars and biosimilar switching is needed to inform patient-centered care strategies that promote efficient resource utilization.MethodsWe used democratic deliberation methods to solicit the informed and considered opinions of patients regarding biosimilar switching. Patients with inflammatory bowel disease (IBD; n = 29) from the Veterans Health Administration (VHA) participated in 5-hour deliberation sessions over two days. Following educational presentations with experts, participants engaged in facilitated small group discussions. Transcripts and facilitators’ notes were used to identify key themes. Participants completed surveys pre- and post-deliberation to collect sociodemographic and clinical features as well as to assess IBD treatment knowledge and attitudes toward care and approaches to biosimilar switching.ResultsFive major themes emerged from the small group discussions in the context of biosimilar switching: 1) concerns about adverse consequences and unclear risk-benefit balance; (2) importance of communication and transparency; (3) desire for shared decision making and patient involvement in treatment decisions; (4) balancing cost-saving with competing priorities; and (5) advocating for individualized care and prioritization based on risk levels. These views led participants to favor approaches that prioritize switching the sickest patients last (i.e., those with poorly controlled disease) and that offer patients control and choices around biosimilar switching. Participants also expressed preferences for combining elements of different approaches to maximize fairness.ConclusionsApproaches to biosimilar switching should consider patients’ desires for transparency and effective communication about biosimilar switching and engagement in their medical decision-making as part of patient-centered care. Incorporating patient preferences around biosimilar switching is critical when navigating the quality and affordability of care in resource constrained settings, both within the VHA and in other healthcare systems.

Doctor and patient perceptions of sarcopenia in community-based primary care clinics: a questionnaire survey.

Our study aims to examine perceptions of sarcopenia among doctors and patients for improved management strategies in the future. We analyzed nine matched items from separate surveys involving 80 community-based primary care doctors, recruited online (55%) and offline (45%), and 80 community-dwelling older patients who visited 6 of the 80 primary care clinics in South Korea. Doctors had a mean age of 58.3 ± 9.1 years, with 17.5% women; patients had a mean age of 74.1 ± 6.1 years, with 61.3% women. Twenty-eight patients (35.4%) had heard of sarcopenia, while only 19 doctors (23.8%) knew the diagnostic criteria of sarcopenia. Patients were more likely to believe they had sarcopenia than doctors assumed their patients had sarcopenia (patients, 35%; doctors, 16.9%; P = 0.0039). Patients desired more exercise and nutritional education than doctors reported they could provide (all P < 0.01). More patients preferred regular text messages for exercise or nutritional education (for exercise: patients 16.5%, doctors 5.8%, P = 0.0428; for nutrition: patients 17.1%, doctors 4.4%, P = 0.0154). Many patients were unaware of available community services for sarcopenia management (patients 48.8%, doctors 10.0%, P < 0.001). Both patients and doctors in community-based primary care clinics lacked awareness of sarcopenia. Significant discrepancies existed between the exercise and nutritional education patients desired and what doctors could provide. These findings can inform the development of sarcopenia management programs in primary care clinics.

The Impact of Social Media on Public Perception and Litigation in Hernia Surgery Complications: A Narrative Review

Title: The Impact of Social Media on Public Perception and Litigation in Hernia Surgery Complications. Introduction: Social media significantly impacts public perception of healthcare, leading to increased litigation for complications after hernia surgery. Our research focused on terms like ‘inguinal hernia repair,’ ‘medico-legal,’ ‘informed consent,’ ‘litigation,’ ‘malpractice,’ ‘social media’, ‘mesh’, ‘Leistenbruch’, and OLG in Pubmed, Google Scholar, and Google. Results showed chronic postoperative pain as a common cause of malpractice claims, with ultrasound being a valuable diagnostic tool. Urological injuries account for a significant portion of complications after surgery. Mesh infection leads to hospital readmission, increased healthcare costs, and lawsuits. The quality of the consent process is crucial, and patient perceptions of mesh use influence their decision-making. Healthcare professionals must understand the impact of social media on public perception and provide comprehensive patient information for informed consent and satisfaction.

A Survey of Patient Utilization and Trust of Emergency Medical Services

Little is known about patients’ decisions to come to the Emergency Department (ED) via emergency medical services (EMS) versus privately owned vehicle (POV); this is problematic as trust in EMS systems impacts patient care decisions. Furthermore, no studies exist that evaluate patients’ trust of the EMS system as it relates to a patient’s race. Patients completed a multi-method survey during their ED stay. Quantitative data included: patient demographics (age, gender, race) income, insurance status, previous medical training, highest level of education, self-reported medical and social history, number of ED visits in the past three months, and two scales assessing trust and empathy: the Group-Based Medical Mistrust Scale and the Jefferson Scale. Characteristics of patients who came to the ED via EMS versus POV were shown. A Wilcoxon signed rank test described differences in EMS trust scales by race. Logistic regression showed which factors contribute to the decision of EMS or POV. Qualitative comments described patients’ rationale for EMS versus POV. 23/72 (31.94%) patients utilized EMS transport and 49/72 (68.06%) utilized POV. 59.09% of patients self-identified as Black and 40.91% self-identified as White. The Group-Based Medical Mistrust Scale found Black patients had less trust in the EMS system (p=0.0001), while the Jefferson Scale of Patient Perception of Physician Empathy showed no significant difference in patient perceptions of EMS provider empathy (p=0.608). Logistic regression indicated that age predicted the use of EMS over POV (p&lt;0.001). Lack of access to POV, physical limitations, cost, speed, perception of emergency, and fear were identified as reasons that supportg patients’ decision to use EMS or POV. Many factors can influence patients’ transportation decisions and this study highlights trust, age, and other social and economic factors. These findings could inform policy decisions and ensure emergency care systems that are accessible for all patients.

Telerehabilitation Program Impact on Overactive Bladder Symptoms and Metabolic Health in Obese Women: a Randomized Controlled Trial

INTRODUCTION. Overactive bladder syndrome is caused by many factors including obesity, insulin resistance and poor dietary habits. Since it is a chronic disease and needs time to be treated, introducing telepilates in addition to Mediterranean diet would encourage better adherence and results to the treatment program. AIM. To assess the impact of a virtual group-based telerehabilitation program on overactive bladder symptoms and metabolic health in women with obesity. MATERIAL AND METHODS. Eighty obese women (BMI 30.0–34.9 kg/m2) between the ages of 35 and 45 were allocated into two equal groups, 40 for each: (A) supervised telepilates and (B) unsupervised telepilates. The supervised group participated in a 12-week Pilates workout program over videoconference platforms three times a week. Meanwhile, the unsupervised group only received four online meetings. The groups’ diet was the Mediterranean style. The Hemostatic Model of Insulin Resistance (HOMA-IR), body mass index (BMI), waist circumference (WC), Patient Perception of Urgency Scale (PPIUS), Overactive Bladder Questionnaire Short Form (OAB-q SF), and Telehealth Usability Scale (TUS) were measured. RESULTS AND DISCUSSION. The supervised telepilates group exhibited statistically significant amelioration of overactive bladder symptoms and a reduction in HOMA-IR (p 0.001), while the unsupervised telepilates group showed insignificant changes in these measures (p 0.05). Furthermore, the supervised telepilates group showed significantly greater reductions in BMI and WC (p 0.001) than the unsupervised telepilates group (p 0.05). Additionally, the supervised telegroup outperformed the unsupervised telegroup on all parameters of TUS (p 0.001) CONCLUSION. Women with obesity experienced decrease in overactive bladder symptoms and improved metabolic health after completing a 12-week telepilates training program.

Development of a Japanese version of the patient perceptions of deprescribing – Short form

AbstractBackgroundDeprescribing is a critical component of clinical practice, especially in geriatric medicine. Nevertheless, the attributes of patients who are prepared for, interested in, and could potentially benefit from deprescribing have not been well examined. The Patient Perceptions of Deprescribing (PPoD) evaluates patients' overall readiness for deprescribing and is complemented by an 11‐item validated short form (SF‐PPoD). The objective of this study was to develop a Japanese version of the SF‐PPoD and assess its reliability and validity within Japanese older adults with polypharmacy.MethodsThe SF‐PPoD was translated, back‐translated, and assessed in a cognitive interview. We conducted a cross‐sectional survey with 196 patients aged 65 years or older with five or more medications using the Japanese version to test for reliability and validity. We examined internal consistency and construct validity to determine if the Japanese sample responses reproduce the two subscales in the original SF‐PPoD. Finally, we examined intra‐person replicability using the intraclass correlation coefficient, in which 100 participants were invited and 93 participated.Results118 males and 78 females, with a mean age of 79.2 [SD 6.5] years, completed the survey. Confirmatory factor analysis of the Japanese version of SF‐PPoD revealed satisfactory structural validity with two‐dimensional structure, “Motivation for Deprescribing” and “Primary Care Physician Relationship.” Cronbach's alpha showed good internal consistency, and test–retest demonstrated acceptable intra‐rater reliability.ConclusionsWe developed and validated a Japanese version of SF‐PPoD with an 11‐item, two‐dimensional structure consistent with the original SF‐PPoD. This scale may facilitate shared decision‐making for medication optimization among older adults living with multimorbidity.

12575 Exploring Patient And Parent Perceptions Of Administering Hydrocortisone Injection During Adrenal Crisis: A Cross-Sectional Study

Abstract Disclosure: S.V. Llahana: None. J. Anhony: Employee; Self; Solution Medical LLC. Background: Adrenal insufficiency (AI) necessitates lifelong glucocorticoid replacement therapy for most patients, with parenteral hydrocortisone crucial for managing adrenal crisis, a potentially life-threatening complication. Despite this, approximately 1 in 6-12 patients are hospitalised at least once a year, while 1 in 200 patients die from a potentially preventable adrenal crisis. While timely self-administration of hydrocortisone mitigates these risks, the complexity of current injection devices, requiring up to 20 steps to administer, often impedes effective self-treatment. Evidence shows that although 70% of patients possess emergency hydrocortisone injection kits, only 19% have received training for self-administration. Aim: This study aimed to investigate the experiences and perceptions of patients with AI and their caregivers regarding the usage of Solu-Cortef Act-O-Vial (parenteral hydrocortisone) for adrenal crisis management. Methods: A cross-sectional online survey was conducted, involving participants recruited through USA-based patient advocacy groups, CARES Foundation and Adrenal Insufficiency United. Participants provided insights into factors influencing their ability to manage adrenal crisis using Solu-Cortef Act-O-Vial. Content analysis generated themes, which were quantitatively analyzed using SPSS descriptive statistics and correlations. Results: The survey encompassed 689 patients and caregivers. Content analysis revealed eighteen themes across three domains: patient-based factors, external influences, and emotional aspects. Predominant themes, identified by over 80% of participants, included the complexity of the hydrocortisone device, the necessity for assistance during adrenal crisis episodes, and emotional distress due to fear associated with injection. Conclusion: This study underscores the necessity for a simpler injection device to enhance patient self-confidence and self-administration ability. Heightened awareness among healthcare professionals and the public regarding adrenal crisis is imperative for timely management and prevention of avoidable hospital admissions. Presentation: 6/3/2024

Uptake of biosimilars in China: a retrospective analysis of the case of trastuzumab from 2018 to 2023

BackgroundThe Chinese biosimilar industry has demonstrated rapid growth in recent years. Limited evidence is available about biosimilar uptake at the national level. This study aimed to assess biosimilar uptake in the case of trastuzumab and to explore potential factors influencing the biosimilar penetration at national and provincial levels.MethodsThis study employed an interrupted time series analysis to assess the level and trend changes of national trastuzumab originator consumption and the overall trastuzumab consumption after the price reduction of the originator and the introduction of the first biosimilar using the China Hospital Pharmacy Audit procurement data from March 2018 to February 2023. A latent class trajectory model (LCTM) was also adopted to estimate the biosimilar penetration across 30 provincial-level administrative divisions (PLADs). Based on the LCTM grouping results, provincial characteristics were analyzed.ResultsAfter rapid growth, the penetration of biosimilars demonstrated a moderate ascending trend at the national level, reaching 27% in February 2023. Following the introduction of the first biosimilar in July 2021, the consumption of the originator decreased by 0.5% per month (P = 0.008), and the growth rate of overall trastuzumab consumption decreased by 1.1% per month (P = 0.014). LCTM fit the best when the number of trajectory classes was two, dividing 30 PLADs into a group demonstrating a faster increase in biosimilar penetration and the other with a slower increase. The PLADs in the fast-increasing group had a higher proportion of the population covered by the national basic health insurance, a lower proportion of the urban population, a lower proportion of the population covered by the urban employee health insurance program, a lower gross domestic product per capita, a lower total health expenditure per capita, and a lower out-of-pocket expenditure.ConclusionsThe uptake of trastuzumab biosimilars in China was lower compared with major European countries. The introduction of trastuzumab biosimilars presented a substitutional effect. Perceptions of physicians and patients, the medicines procurement model, competition from other biologics, and health insurance payment methods may influence biosimilar uptake. Enhancing a comprehensive understanding of biosimilars among physicians and patients, including biologics with biosimilars in the national pooled procurement, and implementing provider payment reforms could foster biosimilar penetration.

Impact of the COVID-19 Pandemic on Lifestyle Behavior and Clinical Care Pathway Management in Type 2 Diabetes: A Retrospective Cross-Sectional Study.

Background and Objectives: In Italy, as in the rest of the world, government restrictions aimed at containing the spread of COVID-19 primarily imposed limitations on social relationships and personal behavior. This situation significantly affected the management of chronic illnesses, including type 2 diabetes (T2D). The objective was to evaluate the perceptions of patients with T2D regarding the quality of care received during the COVID-19 pandemic and the impact on dietary and physical activity behaviors. Materials and Methods: We conducted a retrospective cross-sectional survey. Data were collected from June to July 2023 using the convenience sampling of patients with T2D, and the Patient Assessment of Chronic Illness Care (PACIC) and Medi-Lite questionnaires were administered. Results: During the research period, out of the 130 subjects who met all enrollment criteria, 103 patients were included in this study (79.23%). The results of the administered questionnaires were heterogeneous. The average scores from the PACIC Questionnaire for each question displayed significant variability, indicating a range of experiences in the quality of care. In the Medi-Lite survey, fruit, cereals, and olive oil showed the highest adherence levels, with mean scores ranging from 2.58 (SD ± 1.18) for fruit to 1.89 (SD ± 0.34) for olive oil and 1.97 (SD ± 0.17) for cereals. Patients who reported increased food intake during the lockdown attributed it to having more time to prepare meals. Physical activity levels remained unchanged for 48 patients, decreased for 45 patients, and only 9 patients managed to exercise more during the COVID-19 restrictions. Conclusions: Healthcare systems must prioritize comprehensive care plans for T2D that address not only physical health, but also emotional and social well-being. Post-pandemic, promoting healthier lifestyles and empowering patients to manage their condition is crucial. A multidisciplinary and multidimensional approach could support the care of vulnerable individuals, such as patients with T2D, especially during crises like pandemics or other dramatic events.