Patient Self-reported Information Research Articles

Can circumcision be avoided in adult male with phimosis? Results of the PhimoStopTM prospective trial.

BackgroundCircumcision as surgical treatment of adult phimosis is not devoid of complications. Efficacy of alternative non-surgical options is unclear. PhimoStopTM is a therapeutic protocol which involves the use of appropriately shaped silicone tuboids of increasing size to obtain a non-forced dilation of the prepuce. The aim of the study was to evaluate the efficacy and durability of results of PhimoStopTM device for the treatment of adult male phimosis.MethodsA prospective trial was conducted between 2018 and 2020 on 85 consecutive adult male patients affected by phimosis and with an indication for circumcision. Patients were treated with PhimoStopTM protocol and they were evaluated at baseline and after treatment through a subjective (patient self-reported information on various domains of his sexual function) and an objective assessment (evaluation of phimosis severity grade according to the Kikiros scale pre- and post-treatment, re-assessment of indication for circumcision post-treatment and validated questionnaires scores). Primary endpoint was to avoid the scheduled circumcision in 33% of the patients enrolled.ResultsSeventy-one patients (84%) completed the device usage phase as per study protocol. Median duration of tuboid application was 60 days. Thirty-seven patients (52.1%) had no indication for circumcision after treatment. Even considering patients lost to follow-up as failures, primary endpoint was reached in 43.5% of cases. There was a significant reduction of the grade of phimosis after treatment (P<0.001). Moreover IIEF-5 showed a statistically significant improvement after treatment (P<0.001). Thirty/37 patients who met the primary endpoint (81%) still have a successful resolution of their phimosis avoiding circumcision at a median follow-up of 24 months.ConclusionsPhimoStopTM device is effective for the treatment of adult male phimosis of Kikiros grade ≤2. The results seem to be durable in most patients at a median follow-up of 24 months. Randomized clinical trials are necessary in order to confirm our results and assess cost-efficacy.

Development of an Automated Technology Platform for Preoperative Triage and Patient Preparation.

A proof of concept study was conducted to implement an automated preoperative triage and preparation service with 2 components: (1) triage between preoperative visits and phone screens, and (2) delivery of preoperative instructions to patients. The study enrolled 2604 patients, of whom 75.7% completed the preoperative triage questionnaire and 47.6% were triaged to preoperative phone screens. For the preoperative preparation component, 90.8% of patients viewed surgery preparation instructions, and average patient satisfaction score was 9.3/10. An automated preoperative triage and preparation service can facilitate preoperative triage using patient self-reported information and guide patient preparation with instructions delivered at relevant times.

Teach-Back Experience and Hospitalization Risk Among Patients with Ambulatory Care Sensitive Conditions: a Matched Cohort Study

The teach-back method, also known as the "show-me" method, has been endorsed by many medical and health care societies. However, limited investigation has been conducted regarding its association with patient outcomes. To examine the association between patient teach-back experience and the risk of hospitalizations and length of hospital stay among patients with ambulatory care sensitive conditions (ACSCs). A matched cohort study. Data from the 2011-2015 Longitudinal Medical Expenditure Panel Survey (panels 16-19). Three thousand nine hundred ninety-four US adults aged ≥ 18years with any of 5 ACSCs (hypertension, type 2 diabetes, heart disease, asthma, and chronic obstructive pulmonary disease [COPD]). Hospital admissions (all-cause or ACSC-related) and the length of stay of the first admission were examined by teach-back during interaction with a health provider. Patients with teach-back experience were less likely to experience hospitalization for an ACSC-related condition (relative risk, 0.85; 95% CI, 0.71 to 0.99) and had a lower risk for a condition-related readmission (hazard ratio, 0.77; 95% CI, 0.60 to 0.99), compared with those without teach-back experience. The median length of hospital stay did not differ between patients with teach-back experience and those without teach-back experience (median 3days [IQR 1 to 8days] and median 3days [IQR 0 to 8days], respectively; P =0.84). Subgroup analysis showed that the association of reported teach-back experience on the outcomes was relatively stable among those with hypertension, diabetes, and heart disease, but was not among those with asthma or COPD. Teach-back exposure relied on patient self-reported information. Our findings suggest that patient teach-back method is associated with reduced risk of hospitalization for those with ACSCs, especially among patients with cardiovascular diseases and type 2 diabetes. Encouraging providers to utilize the teach-back method at every visit has the potential to further reduce hospitalizations for individuals with ACSCs.

Factors associated with costs and health outcomes in patients with Back and leg pain in primary care: a prospective cohort analysis

BackgroundThere is limited research on the economic burden of low back-related leg pain, including sciatica. The aim of this study was to describe healthcare resource utilisation and factors associated with cost and health outcomes in primary care patients consulting with symptoms of low back-related leg pain including sciatica.MethodsThis study is a prospective cohort of 609 adults visiting their family doctor with low back-related leg pain, with or without sciatica in a United Kingdom (UK) Setting. Participants completed questionnaires, underwent clinical assessments, received an MRI scan, and were followed-up for 12-months. The economic analysis outcome was the quality-adjusted life year (QALY) calculated from the EQ-5D-3 L data obtained at baseline, 4 and 12-months. Costs were measured based on patient self-reported information on resource use due to back-related leg pain and results are presented from a UK National Health Service (NHS) and Societal perspective. Factors associated with costs and outcomes were obtained using a generalised linear model.ResultsBase-case results showed improved health outcomes over 12-months for the whole cohort and slightly higher QALYs for patients in the sciatica group. NHS resource use was highest for physiotherapy and GP visits, and work-related productivity loss highest from a societal perspective. The sciatica group was associated with significantly higher work-related productivity costs. Cost was significantly associated with factors such as self-rated general health and care received as part of the study, while quality of life was significantly predicted by self-rated general health, and pain intensity, depression, and disability scores.ConclusionsOur results contribute to understanding the economics of low back- related leg pain and sciatica and may provide guidance for future actions on cost reduction and health care improvement strategies.Trial registration13/09/2011 Retrospectively registered; ISRCTN62880786.

The Power of the Patient Voice: Learning Indicators of Treatment Adherence From An Online Breast Cancer Forum

Social media platforms have become popular online environments for patients seeking and sharing treatment experiences. These platforms enable us to move beyond traditional sources of clinical information for learning about a patient's long-term adherence to treatment. While adherence has been studied using data derived from medical records and structured surveys, these approaches are limited in that they are often 1) time consuming, 2) limited in scale, or 3) lack self-reported patient experiences. In this paper, we investigate treatment adherence through a patient's self-reported information in online discussion forums. Specifically, we consider hormonal therapy treatment adherence (HTA) for hormone receptor positive breast cancer, a disease subtype that comprises 75% of all breast cancer cases. We focus on the inferred emotions and personality traits from the posts created by the members of a large online breast cancer community. These factors have been neglected in traditional adherence research due to a lack of information. We study over 130,000 posts from the forum, spanning 10,000 patients over 9 years. We assess emotion and personality traits with respect to three types of adherence behaviors: 1) currently on a regimen, 2) an interruption (due to discontinuing, pausing, or switching a medication regimen before five years) and 3) the completion of a five-year protocol. We find statistically significant differences in emotions across adherence behaviors. We further show that specific personality traits, including self-discipline, are associated with HTA, but in the opposite direction than what traditional research studies have shown. Finally, we illustrate that there is potential for predicting future interruption behaviors based on an individual's posts. We anticipate that our methodology can be applied to study treatment adherence for other diseases using online self-reported information.

Discrepancies identified with the use of prescription claims and diagnostic billing data following a comprehensive medication review.

The University of Florida College of Pharmacy's Medication Therapy Management Communication and Care Center (UF MTMCCC) provides medication therapy management (MTM) services to patients enrolled in a State of Florida Medicaid Waiver Program: Medicaid for the Aged and Disabled. To provide these services, UF MTMCCC was given access to patients' prescription claims data and diagnostic billing data in the form of ICD-9 codes. Prior to calling a patient, a precomprehensive medication review (CMR) work-up was performed to identify potential medication-related problems (MRPs) and/or health-related problems (HRPs). Based on information provided by the patient in relation to comorbidities, medications, and medical history during the interactive telephone conversation, problems were either confirmed or eliminated. All of the reported information was also assessed to identify any new MRPs or HRPs. Accordingly, telephonic MTM services have the potential to bridge the gap between pharmacy claims data and patient self-reported information, since the MTM services provided rely on the accuracy of both informational resources. To determine the degree of discrepancy in patient-reported information regarding chronic comorbidities and medications versus diagnostic billing data (ICD-9 codes for chronic comorbidities) and pharmacy claims data (medications) when providing MTM services during an interactive telephonic comprehensive medication review. A retrospective chart review (n = 147 patients) was performed for patients who received a telephonic CMR. Pharmacy claims data and diagnostic billing data, in conjunction with the pre-CMR work-up data, were used to identify discrepancies in information obtained from the patient during the CMR. During the chart review, identified MRPs or HRPs were categorized as "confirmed" (patient reported the problem exists and/or it was deduced from the presence/absence of a medication that the problem does exist); "eliminated" (patient reported the problem does not exist and/or it was deduced from the presence/absence of a medication that the problem does not exist); or "new" (a problem that was not identified during precall identification of problems, but following the CMR interaction, it was determined that a problem now exists). The study evaluated the discrepancies before and after a CMR telephonic interaction in the following categories: medications, chronic comorbidities, level 1 drug-drug interactions, level 2 drug-drug interactions, gaps in therapy, therapeutic duplications, lack of therapy, preferred drug list alternatives, combination products, and tobacco use. Percent discrepancy was calculated as the sum of new and eliminated data elements divided by the total number of data elements for each MRP or HRP. The percent discrepancy observed was 42% for medications, 41% for chronic comorbidities, 77% for level 1 drug-drug interactions, 93% for level 2 drug-drug interactions, 35% for gaps in therapy, 87% for therapeutic duplications, 26% for lack of therapy, 36% for preferred drug list alternatives, 42% for combination products, and 54% discrepancy for report of tobacco use. Overall, 4,441 data elements were identified as confirmed, eliminated, or new across the 147 CMRs. Among those data elements, 56% of the data was confirmed; 23% was eliminated; and 21% was discovered as new. The study met its objective in determining the degree of discrepancies that existed when prescription claims data and ICD-9 billing data were used to identify MRPs and/or HRPs versus using patient-reported data. Data revealed that the presence of discrepancy is relatively large depending on the category, indicating a difficulty in accurately making recommendations with incomplete data or solely based on prescription claims and billing data. MTM services with patient interaction are vital in identifying information that allows for more appropriate decision making.

Concordance of self-reported and medical chart information on cancer diagnosis and treatment

BackgroundSelf-reported information is an important tool for collecting clinical information for epidemiologic studies and in clinical settings where electronic medical records are not employed and shared.MethodsUsing data collected from the Shanghai Breast Cancer Survival Study (SBCSS), a population-based, prospective cohort study of 5,042 women diagnosed with breast cancer in Shanghai, China, we compared the concordance of patient questionnaire responses to a survey administered approximately 6 months after cancer diagnosis with medical chart information obtained from the diagnostic hospitals for several disease and treatment-related variables.ResultsOf 5,042 SBCSS participants, medical chart information was available for 4,948 women (98.1%). Concordance between patient self-reported and medical chart information was high for the majority of disease-related variables, including: diagnosing hospital (agreement: 98.7%, kappa: 0.99), type of surgery conducted (94.0%, 0.53), ER/PR status (94.5%, 0.91), and tumor position (98.2%, 0.97), as well as for important calendar dates, such as date of diagnosis, surgery, and first chemotherapy treatment. The 10 most commonly used chemotherapeutic drugs were all reported with agreement rates of at least 82%, with associated kappa values that ranged from 0.41 for calcium folinate to 0.76 for vinorelbine.ConclusionsOur study found high validity for patient self-reported information for a variety of disease and treatment-related variables, suggesting the utility of self-reports as an important source of clinical information for both epidemiological research and patient care.

Commentary: Encouraging Clinicians to Incorporate Longitudinal Patient-Reported Symptoms in Routine Clinical Practice

Commentary: Encouraging Clinicians to Incorporate Longitudinal Patient-Reported Symptoms in Routine Clinical Practice

Patient Characteristics Associated with Receipt of Lifestyle Behavior Advice

Lifestyle behaviors such as reducing weight if overweight or obese, reducing salt intake, exercising, reducing alcohol intake, quitting smoking, and eating a healthy diet are related to the prevention and control of chronic diseases. However the amount of lifestyle advice provided by clinicians has been declining over the last decade. In 2002, a telephone survey was conducted to assess the quality of preventive care offered by health care providers. The study was a cross-sectional observational study of a randomly selected sample of 516 diverse individuals in Durham County, North Carolina. Information regarding age, sex, race, education, health conditions, and self-reported receipt of lifestyle advice was examined in the study. The odds of receiving advice to engage in preventive lifestyle behaviors were significantly higher for those with a pre-existing diagnosis of diabetes or hypertension and for participants reporting poor health status. For example, the odds of receiving advice to control or lose weight was 8.32 (95% CI, 2.65, 26.75) among individuals reporting a diagnosis of diabetes. Similarly, the odds of reporting "receiving advice to reduce salt intake" was 6.97 (95% CI, 3.74, 13.00) among subjects reporting a diagnosis of hypertension. The results are from a cross-sectional study of a sample of individuals in only one county. Additionally, the results are based on patient self-reported information, which could be subject to recall and social desirability bias. Patients with identified health problems were more likely than others to report being advised to adopt healthy lifestyle recommendations. Future research should examine methods to encourage health care providers to offer lifestyle advice to those without pre-existing illness.

Australian Schizophrenia Care and Assessment Programme: Real-World Schizophrenia: Economics

The treatment of patients with schizophrenia consumes a considerable proportion of health service budgets, yet there have been few attempts to prospectively analyse the costs associated with this condition. Amid the current debate about where to invest scarce treatment resources to achieve optimal outcomes, real-world studies, such as the Schizophrenia Care and Assessment Programme (SCAP) contrast with hypothetically based models and provide comprehensive and broad-ranging data. Direct health-care costs were prospectively studied in a cohort of 347 patients with schizophrenia in Dandenong, Australia over 3 years. Indirect costs were estimated from patient self-reported information. The average annual societal cost was AU $32,160 per participant in the first year of the study, AU $27,190 in the second year and AU $29,181 in the third year. Indirect costs accounted for 46% of the total costs in the first year, 52% of the total costs in the second year and 50% of the total costs in the third year. The most expensive component of treatment was inpatient hospital care, which accounted for 42%, 34% and 36% of the total costs in the first, second and third year, respectively. Considerable resources are required for the provision of treatment for patients with schizophrenia. But for the majority of people in this cohort, funding assertive treatment programmes and measures to reduce hospitalization was accompanied with enhanced functioning and quality of life, as well as a reduction in long-term societal and government costs. The distribution of health-care costs is highly skewed, with a relatively small proportion of patients (39%) consuming the majority of resources (80%). Improving rates of employment for this patient group could hold substantial benefits in reducing the overall economic and personal impact of this disorder.