Promote Patient Empowerment Research Articles

Impact of Virtual Navigation on the Education and Access of Patients with Cancer: A National Mixed Methods Investigation.

Despite growing evidence of efficacy, oncology patient navigation is not ubiquitously offered. Navigation may reduce barriers to cancer care, yet geographic location may limit patient access. To overcome geographical barriers and increase patient education in oncology, our medical center developed a virtual navigation program. To examine the efficacy of the Virtual Navigation Program designed to increase patient access and education across local and national contexts. In this mixed-methods study, a total of 105 individuals completed an online survey administered nationally to oncology patients who used the navigation program. Clinical and demographic data were collected. Nonparametric tests were used for group comparisons (Wilcoxon Signed-Ranks test). Virtual navigation increased access as the majority of patients utilized the Virtual Navigation Program beyond the local area; 42% of patients were local; 58% were patients located across the US. 55 (52%) were female; 25% were non-White. Pancreatic cancer was the largest tumor type: 51 (49%). Patients agreed the virtual cancer education helped them make critical health choices (mean 4.89 SD = 84); understand their diagnosis (mean 4.44 SD = .77); were able to make informed decisions (mean 4.43 SD = .83), and empowered to manage their cancer care (mean 4.58 SD = .82). Post navigation, the user experience survey revealed significant increases in a subset of patients' cancer knowledge (P < 0.001), access to quality cancer education (P = 0.045), decision-making in cancer care (P < 0.05), and coordinated cancer care (P = 0.03). This study explores a unique role that virtual navigation may play in helping accommodate healthcare for many cancer patients in underserved areas. The use of innovative aspects of research and education in virtual navigation may be successful in promoting patient empowerment in the cancer continuum. Internet-strategies are needed to inform sustainable patient navigation in low-resource contexts.

Improving healthcare at home for complex chronic patients (CCPs) in Andalusia (JADECARE pilot)

Introduction: A Complex Chronic Disease is a condition involving multiple morbidities that requires the attention of multiple health care providers and, therefore, a holistic approach. &#x0D; The Andalusian Public Health System is responsible for the provision of healthcare and public health services to the Andalusian population (8.5 million inhabitants), where around 200000 complex chronic patients (CCPs), with chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) have been identified and prioritized. Healthcare at home for CCPs is considered a key element that facilitates patient follow-up, can avoid emergency episodes, promoting patient empowerment.&#x0D; The Andalusian participation in the EU Joint Action JADECARE “joint action on implementation of digitally enabled integrated person-centered care” (GA 951442) focuses on improving healthcare at home for CCPs with CHF and COPD. The development, implementation and testing of a Centralised System for Proactive Follow-up (SCSP) of chronic patients is being monitored, as well as the tele-referral service which is being expanded. The SCSP is supported by National funds as well (Servicio para la implantación de una solución corporativa para el seguimiento proactivode pacientes crónicos en el sistema sanitario público de Andalucía (Expdte. 039/21-SP.).&#x0D; The aim of the JADECARE Andalusian pilot is to improve health status and quality of life of CCPs by enhancing home healthcare proactive follow-up and its evaluation.&#x0D; Method: The development, implementation and testing of the Centralised System for Proactive Follow-up of chronic patients within Andalusian Public Health System includes several steps, from tendering, SCSP design and development, to training and assessment.&#x0D; The SCSP will allow to gather information from home healthcare of CCPs integrated in the corporate IT system and EHR (Diraya). The platform will be a key element for healthcare professionals in the proactive and remote monitoring of chronic patients, allowing early identification of warning signs/signals, adaptation of prescriptions, anticipation of health problems, providing support to caregivers and avoiding unplanned inpatient episodes. This SCSP will be monitored as well as the tele-referral system for CCPs.&#x0D; &#x0D; Results, Conclusions and Lessons learned: Results of this pilot will be presented during the conference. Process, outcomes, patients’ satisfaction and technology acceptance model indicators will be measured.&#x0D; The SCSP is expected to facilitate patients’ follow-up, improving continuity of care by healthcare professionals and patients’ quality of life.&#x0D; Discussions: The Andalusian JADECARE pilot is aligned with the Andalusian Comprehensive Healthcare Plan for Patients with Chronic Diseases and the Andalusian Comprehensive Care Plan, and takes into account the experience of the “Digital roadmap towards an integrated health care sector”, from the Region of Southern Denmark.&#x0D; An integrated healthcare system linked to a solid corporate IT system allow the development of a Centralised System for Proactive Follow-up of chronic patients that leads to an improvement of patient care and quality of life while public healthcare resources are optimized.&#x0D; Limitations: Health outcomes assessment in the timeframe of the project.&#x0D; Suggestions for future research: Home healthcare monitoring assessment.

Informing Patient-Provider Engagement for Shared Decision Making Through Mobile Health Applications.

The study utilized a cross-sectional dataset to identify demographic and health factors associated with patient utilization of mHealth applications for engaging with healthcare providers. The focus was on adults with chronic health conditions as the primary app user group. The goal was to reveal specific barriers and facilitators to app adoption among smartphone users, with the aim of highlighting opportunities for upgrades that promote patient empowerment as a prerequisite for shared decision-making (SDM). Data from the Health Information National Trends Survey (HINTS 5, Cycle 4, 2020) with 3865 respondents (≥18 years old) stratified analyses and weighted logistic regression were used. The study found that individuals having a wellness app on a smartphone increased the likelihood (OR 2.68, CI: 2.02-3.56, p-value < 0.0001) of discussing health conditions with providers. Furthermore, individuals with multiple chronic health conditions were more likely (OR 1.93, CI 1.26-2.95, p-value < 0.01) to use apps to use mobile health applications to engage with healthcare providers. Other significant variables affecting app usage such as race, marital status, and educational level. Due to difficulties obtaining in-person healthcare, the COVID-19 epidemic forced a swift deployment of mHealth technologies. Even in the absence of a crisis, mobile health applications continue to be crucial for improving patient-provider engagement and developing novel approaches to healthcare delivery. During the pandemic, people with numerous chronic diseases used apps to stay in touch with doctors and maintain their reliance on these platforms. Nonetheless, different smartphone users continue to use mHealth application in different ways. The findings revealing barriers in mHealth app adoption among certain patient subgroups suggest opportunities for developers, in collaboration with users and providers, to enhance inclusion and acceptability when upgrading mHealth application platforms.

"Connected device for monitoring patients treated by prostatectomy: Implementation and qualitative assessment"

Support care aims to improve the experience of patients. m-health is one of the tools recently developed to promote patient empowerment. The objective of this study was to evaluate the appreciation of an m-health application to enhance prostatectomy path for patients suffering from prostate cancer. A prospective monocentric study was conducted in the urology department of the University Hospital of Rennes from February to April 2023. MyCHU application was optimized by integrating information sheets in the postoperative period after prostatectomy on sphincter rehabilitation exercises, erectile dysfunction and urinary incontinence. The questionnaire used to evaluate the usability of "MyCHU" application was the System Usability Scale (SUS). Semi-structured interviews explored the patients' feelings about the content of the information sheets and the impact on their empowerment regarding sexual disorders. Twelve patients participated in this study and 7 agreed to complete an interview The average SUS score was 75.58, which indicate an high usability. Patients appreciated the fact that the application structured their healthcare pathway by centralizing information. The information sheets were clear and accurate. The impact on their empowerment was positive, with a gain in their ability to take ownership of the therapies. The role of digital technology in health care has been growing in recent years. Our study has shown the interest that mobile application can bring to the patient who undergoes prostatectomy. It increases his empowerment and favor the dialogue with his surgeon.

Complementing traditional care with digital therapeutics for chronic non-communicable disease management

Abstract We will examine the role of digital therapeutics in diabetes care, where we will discuss how Digital Therapeutics can supplement face-to-face consultations by facilitating data exchange between patients and healthcare professionals, improving disease monitoring, and promoting patient empowerment. In the context of mental health, we will present evidence supporting the effectiveness of computer-assisted cognitive behaviour therapy (CCBT) as a valuable adjunct to treatment as usual (TAU) in primary care settings. Throughout the presentation, we will highlight the importance of integrating digital therapeutics into existing healthcare systems and addressing barriers to their adoption, such as socio-demographic disparities and healthcare professional attitudes through tools such as regulatory frameworks and reimbursement pathways. By exploring the complementary role of digital therapeutics in chronic NCD management, we aim to encourage dialogue on the potential synergies between traditional care and digital interventions to improve patient outcomes and inform public health policy.

The use of social media in the self-management of chronic diseases: views of patients and doctors

Abstract Background Despite the deep integration of social media into daily self-management practices of people living with chronic conditions, there are still conflicting opinions about the role of social media in disease self-management. Comparing the perspectives of patients and physicians is useful in understanding potential tensions and facilitating more effective collaboration between patients and physicians. The aim of the research was to find out the opinions of patients and doctors about the benefits and risks of using social media for disease self-management. Methods We used mixed methods convergent parallel design combined an internet survey and in-depth interviewing. We collected data from online questionnaire posted in online communities for people with chronic diseases on social media platforms Vkontakte and Facebook (N 204). The qualitative phase used in-depth interviews with doctors (N 23). We analyzed quantitative data in SPSS and qualitative data in Nvivo. Results From the perspective of patients, the main benefits include access to information about treatment through peer-to-peer expertise (70,8%) and sharing personal experience of disease (60,9 %). Patients indicated risks of unproved information (92,2%) and breach of anonymity (71,5%). All interviewed doctors were skeptical about benefits of the use of social media by patients. They see the main risks in the dissemination of unreliable and unqualified information about treatment and the destruction of the usual patterns of doctor-patient relationship. Conclusions There are contradictions between views of patients and doctors on benefits and risks of using social media in disease self-management. Doctors underestimate the role of social media in chronic diseases self-management and doubt in ability of patients to critically evaluate information. Key messages • Understanding differences in viewpoints can help improve doctor-patient relationships in an eHealth environment. • Resalts promotes patient empowerment. Research was supported by RSF (project No 22-18-00261).

Implementation of trauma-informed care and trauma-responsive services in clinical settings: a latent class regression analysis.

Engagement and retention in health care is vital to sustained health among people living with HIV (PLWH), yet clinical environments can deter health-seeking behavior, particularly for survivors of interpersonal violence. PLWH face disproportionate rates of interpersonal violence; clinical interactions can provoke a re-experiencing of the sequalae of trauma from violence, called re-traumatization. Trauma-informed care (TIC) is a strengths-based approach to case that minimizes potential triggers of re-traumatization and promotes patient empowerment, increasing acceptability of care. Yet, Ryan White HIV/AIDS clinics, at which over 50% of PLWH received care, have struggled to IMPLEMENT TIC. In this analysis, we sought to (1) identify unique sub-groups of HIV clinics based on clinical attributes (i.e., resources, leadership, culture, climate, access to knowledge about trauma-informed care) and (2) assess relationships between sub-group membership and degree of implementation of TIC and trauma-responsive services offered. A total of 317 participants from 47 Ryan White Federally-funded HIV/AIDS clinics completed a quantitative survey between December 2019 and April 2020. Questions included assessment of inner setting constructs from the Consolidated Framework for Implementation Research (CFIR), perceived level of TIC implementation, and trauma-responsive services offered by each respondent's clinic. We employed latent class analysis to identify four sub-groups of clinics with unique inner setting profiles: Weak Inner Setting (n = 124, 39.1%), Siloed and Resource Scarce (n = 80, 25.2%), Low Communication (n = 49, 15.5%), and Robust Inner Robust (n = 64, 20.2%). We used multilevel regressions to predict degree of TIC implementation and provision of trauma-responsive services. Results demonstrate that clinics can be distinctly classified by inner setting characteristics. Further, inner setting robustness is associated with a higher degree of TIC implementation, wherein classes with resources (Robust Inner Setting, Low Communication) are associated with significantly higher odds reporting early stages of implementation or active implementation compared to Weak class membership. Resourced class membership is also associated with availability of twice as many trauma-responsive services compared to Weak class membership. Assessment of CFIR inner setting constructs may reveal modifiable implementation setting attributes key to implementing TIC and trauma-responsive services in clinical settings. Introduction.

Trauma-Informed Care for Acute Care Settings: A Novel Simulation Training for Medical Students.

Physicians often care for patients who have experienced traumatic events including abuse, discrimination, and violence. Trauma-informed care (TIC) is a framework that recognizes the prevalence of trauma, promotes patient empowerment, and minimizes retraumatization. There are limited education curricula on how to apply TIC to acute care settings, with simulation-based training presenting a novel educational tool for this aim. Students participated in a didactic on TIC principles and its applications in acute care settings. Learners participated in three simulation cases where they performed physical exams and gathered history on patients with urgent medical needs related to intimate partner violence, transgender health, and health care discrimination. Debriefing followed each simulation. Seventeen medical students participated across four sessions. The sessions were evaluated with pre- and postparticipation surveys, including Likert scales and free-response questions. After participation, individuals' self-assessed confidence improved across multiple domains, including identifying situations for trauma screenings, inquiring about trauma, and responding as a bystander. Learners also felt more familiar with TIC-specific history taking and physical exam skills. Finally, simulation was perceived as a beneficial educational tool. All findings were statistically significant (p ≤ .01). Our simulation-based training enabled students to practice conversations and interventions related to trauma. This novel training represents a feasible and effective means for teaching TIC for acute care settings, including in the emergency department and in-patient settings. Development and evaluation were supported by the Society for Academic Emergency Medicine.

Telemonitoring program for genito-urinary cancer patients treated with oral anticancer agents.

e18731 Background: Oral anticancer agents (OAA) used has dramatically increased in treating genito-urinary (GU) cancer. Patients with metastatic prostate and kidney cancers, have advanced age, with comorbidities. The risks of OAA for this population with adverse effects, drug interactions and ambulatory administration must be detected, prevented and managed to decrease toxicity, improve compliance and efficacy. Here, we report the data of our comprehensive cancer center telemonitoring program named Outside the walls of the hospital (OWH), combining medical oncologist coordination, clinical pharmacist (CP) evaluations, and nurse follow-ups. Methods: Data from patients treated with OAA for advanced and metastatic prostate or kidney cancers in our center during year 2022 were retrospectively evaluated. At the start of OAA, the patients benefit from a consultation with the oncologist, clinical nurse (CN), and CP. For each drug, a standard telemonitoring program has been planned according to the patient's age and comorbidities. Results: The mean age of the patients was 68 years (44-90), 42% of the patients were over 70 years, 84% were men and 96% were in a metastatic setting. Out of 347 GU patients, 118 were included in the OWH telemonitoring program in 2022, representing 14% of the whole cancers patients enrolled in this program. Of these 118 new GU patients, 80% had a CP consultation, 76% for next generation hormonal therapy (NGHT) for advanced or metastatic prostate cancer and 24% for tyrosine kinase inhibitors (TKI) for kidney cancer. At least one drug interactions was detected for 54% of patients (61% of the NGHT and 35% of TKI). The associations was strongly discouraged for 18% because of an increase or decrease in drug concentration requiring a switch or an adaptation of dosage at the outset (statin (11 patients), oral anticoagulant (5 patients), analgesic (1 patient)). At least 1 complementary alternative medicine was used by 29% with 55% of them had an interaction with OAA. During follow-up, the frequency of consultations with CN or physician is reduced over time, in order to give priority to telemonitoring and visits to the oncologist for tumor assessment and if necessary at the request of the nurse or the patient. Conclusions: The OWH program makes it possible to limit medical visits by ensuring safe monitoring. It promotes patient empowerment and allows for medical visits when necessary, in the current context of declining medical demographic for an often elderly and fragile population.

A Mobile App (Concerto) to Empower Hospitalized Patients in a Swiss University Hospital: Development, Design, and Implementation Report.

Patient empowerment can be associated with better health outcomes, especially in the management of chronic diseases. Digital health has the potential to promote patient empowerment. Concerto is a mobile app designed to promote patient empowerment in an in-patient setting. This implementation report focuses on the lessons learned during its implementation. The app was conceptualized and prototyped during a hackathon. Concerto uses hospital information system (HIS) data to offer the following key functionalities: a care schedule, targeted medical information, practical information, information about the on-duty care team, and a medical round preparation module. Funding was obtained following a feasibility study, and the app was developed and implemented in four pilot divisions of a Swiss University Hospital using institution-owned tablets. The project lasted for 2 years with effective implementation in the four pilot divisions and was maintained within budget. The induced workload on caregivers impaired project sustainability and warranted a change in our implementation strategy. The presence of a killer function would have facilitated the deployment. Furthermore, our experience is in line with the well-accepted need for both high-quality user training and a suitable selection of superusers. Finally, by presenting HIS data directly to the patient, Concerto highlighted the data that are not fit for purpose and triggered data curation and standardization initiatives. This implementation report presents a real-world example of designing, developing, and implementing a patient-empowering mobile app in a university hospital in-patient setting with a particular focus on the lessons learned. One limitation of the study is the lack of definition of a "key success" indicator.

Patient, family member, and ambulance staff experiences of prehospital acute pain management in adults: A systematic review and meta-synthesis.

We aimed to synthesize the qualitative experiences of patients, their family members, and ambulance staff involved in the prehospital management of acute pain in adults and generate recommendations to improve the quality of care. A systematic review was conducted following the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) guidelines. We searched from inception to June 2021: MEDLINE, CINAHL Complete, PsycINFO and Web of Science (search alerts were screened up to December 2021). Articles were eligible for inclusion if they reported qualitative data and were published in the English language. The Critical Appraisal Skills Program for qualitative studies checklist was used to assess risk of bias, thematic synthesis was performed on included studies and recommendations for clinical practice improvement were generated. Twenty-five articles were included in the review, representing over 464 patients, family members, and ambulance staff from 8 countries. Six analytical themes and several recommendations to improve clinical practice were generated. Strengthening the patient-clinician relationship by building trust, promoting patient empowerment, addressing patient needs and expectations, and providing a holistic approach to pain treatment is key to improving prehospital pain management in adults. Shared pain management guidelines and training across the prehospital and emergency department intersection should improve the patient journey. Interventions and guidelines that strengthen the patient-clinician relationship and span the prehospital and emergency department phase of care are likely to improve the quality of care for adults suffering acute pain in the prehospital setting.

Summative content analysis of the recommendations from Project ECHO Ontario Autism.

Practitioners report a lack of knowledge and confidence in treating autistic children, resulting in unmet healthcare needs. The Extension of Community Healthcare Outcomes (ECHO) Autism model addresses this through discussion of participant-generated cases, helping physicians provide best-practice care through co-created recommendations. Recommendations stemming from ECHO cases have yet to be characterized and may help guide the future care of autistic children. Our objective was to characterize and categorize case discussion recommendations from Project ECHO Ontario Autism to better identify gaps in clinician knowledge. We conducted a summative content analysis of all ECHO Ontario Autism case recommendations to identify categories of recommendations and their frequencies. Two researchers independently coded recommendations from five ECHO cases to develop the coding guide. They then each independently coded all remaining cases and recommendations from three cycles of ECHO held between October 2018 to July 2021, meeting regularly with the ECHO lead to consolidate the codes. A recommendation could be identified with more than one code if it pertained to multiple aspects of autism care. Categories from the various codes were identified and the frequency of each code was calculated. Of the 422 recommendations stemming from 62 cases, we identified 55 codes across ten broad categories. Categories included accessing community resources (n = 224), referrals to allied health and other providers (n = 202), ongoing autism care (n = 169), co-occurring mental and physical health conditions (n = 168), resources and tools for further learning (n = 153), physician to provide education and coaching to families (n = 150), promoting parent and family wellness (n = 104), supporting community autism diagnosis (n = 97), promoting patient empowerment and autonomy (n = 87), and COVID-19 (n = 26). This is the first time that recommendations from ECHO Autism have been characterized and grouped into categories. Our results show that advice for autism identification and management spans many different facets of community-based care. Specific attention should be paid to providing continued access to education about autism, streamlining referrals to allied health providers, and a greater focus on patient- and family-centered care. Physicians should have continued access to autism education to help fill knowledge gaps and to facilitate families' service navigation.

Implementing an innovative, patient-centered approach to day case arthroplasty: improving patient outcomes through remote preoperative pharmacist consultations

ObjectiveElective surgery suffered significant loss of capacity during the COVID-19 pandemic. To address this, hip and knee arthroplasties are being conducted as day case procedures. Pre-admission pharmacist consultations were introduced...

A Novel Empowerment System for Patients Living with a Chronic Disease in a Precarious Context.

Nurses play an important role in the management of chronic diseases. Here, we discuss the components of a novel system aimed at empowering patients living with chronic diseases, such as chronic obstructive pulmonary disease (COPD), in a context of precariousness for patients and health personnel, including nurses. This project aimed to evaluate the impact of nursing consultation and remote monitoring on the quality of life in patients with COPD. Two essential elements were linked to promote patient empowerment, which included a network of relationships among the community, hospital, and academic institutions as well as the promotion, contextualization, and co-management of therapeutic education programs among patients. Our results are applicable to all countries with vulnerable populations.

Digital health activism of patients with chronic diseases: discursive strategies and themes

Abstract Background On the Internet, there are many online communities where people living with chronic life-threatening diseases can discuss their problems. On the one hand, digital health activism promotes patient empowerment and could lead to better disease self-management. But, on the other hand, digital health activism raises concerns as it undermines the monopoly of expert medical knowledge. The objective of the research was to reveal the main discursive strategies and themes represented in Russian-language online communities for people with chronic life-threatening diseases. It could help to gain a better understanding of the purposes and effects of digital health activism on patients. Methods Data were collected through the popular Russian-language social networking site “Vkontakte”. We selected open groups with memberships of more than 1000 users devoted to HIV/AIDS, cancer, tuberculosis, and diabetes. Discourse analysis and thematic analysis were implemented. Results Revealed discursive strategies include the patients’ rights advocacy and resistance to the established order of health care. Three main types of discursive themes were identified: a. Overcoming shortcomings of the health care system such as lack of qualified doctors, medicine shortage, and unethical behavior of health care personnel. b. Overcoming the monopolization of expert medical knowledge and criticizing some treatment approaches. c. Overcoming stigma and discrimination associated with disease both in healthcare settings and in everyday life. Conclusions Research on digital activism of patients with chronic life-threatening diseases makes it possible to identify hidden discrimination practices and patient rights violations in healthcare settings. Members of online patient communities turn from objects of care into informed active subjects who critically evaluate medical prescriptions, are active in finding the better treatment, and in defending their rights. Key messages • The research contributes to the revision of the paternalistic model of patient-doctor interaction. • Attention to digital activism is important for the identification of hidden issues in healthcare.The research was supported by RSF (project No 22-18-00261).

Patient Support Groups in Rheumatic Diseases: An Evolving and Essential Component of Patient Care

Patient support groups, also known as patient advocacy organizations, offer instrumental, emotional, research opportunities and even fundraising to support patients, families, and caregivers affected by certain diseases. The support groups offer therapeutic benefits, not only medically, but also psychosocial aspects of the patients. They serve to increase disease awareness among the patients, public and health professionals which results in promoting patient empowerment in self-management and improving the overall support network for the patients. Rheumatic diseases are often chronic, progressive autoimmune conditions which commonly cause physical symptoms, functionality disability, psychological, social, and economic impact on the patients’ lives. However, limitations such as lack of access to local support groups especially with the rare diseases, and difficulty in sustaining a group due to funding and leadership issues, do exist. This article focuses on the role of the patient support group in complementing the medical treatment provided by health professionals among patients with rheumatic diseases and ways to enhance the sustainability of patient support group.

Literature Review on Artificial Intelligence Methods for Glaucoma Screening, Segmentation, and Classification.

Artificial intelligence techniques are now being applied in different medical solutions ranging from disease screening to activity recognition and computer-aided diagnosis. The combination of computer science methods and medical knowledge facilitates and improves the accuracy of the different processes and tools. Inspired by these advances, this paper performs a literature review focused on state-of-the-art glaucoma screening, segmentation, and classification based on images of the papilla and excavation using deep learning techniques. These techniques have been shown to have high sensitivity and specificity in glaucoma screening based on papilla and excavation images. The automatic segmentation of the contours of the optic disc and the excavation then allows the identification and assessment of the glaucomatous disease’s progression. As a result, we verified whether deep learning techniques may be helpful in performing accurate and low-cost measurements related to glaucoma, which may promote patient empowerment and help medical doctors better monitor patients.

Patient Empowerment and Associations with Disease Activity and Pain-Related and Lifestyle Factors in Patients With Rheumatoid Arthritis.

BackgroundEmpowerment is important to patients with rheumatoid arthritis (RA) because most care is in the form of self‐management. The aim was to study levels of empowerment and associated variables in patients with RA and to investigate longitudinal clinical data in patients with low and high empowerment.MethodsA postal survey was sent in 2017 to patients with RA from the BARFOT (Better Anti‐Rheumatic Pharmacotherapy) cohort that included questions about disease activity, pain‐related factors, lifestyle habits, and contained the Swedish Rheumatic Disease Empowerment Scale (SWE‐RES‐23). The 844 patients who answered the SWE‐RES‐23 made up the cohort of the present study. Differences in level of empowerment between groups (low, moderate, and high empowerment) were analyzed with ANOVA. Logistic regression analysis was used to study variables associated with low empowerment. Thirdly, we performed comparisons in longitudinal data (15 years) of disease activity, pain, and physical function between the three empowerment groups (low, moderate, and high empowerment).ResultsPatients with low empowerment (n = 282) were significantly older, more often women, and reported worse pain‐related factors and physical function and lower moderate and vigorous physical activity compared with those with high empowerment (n = 270). An analysis of longitudinal data found that patients with low empowerment had worse pain and physical function at all time points.ConclusionPatients with low empowerment have more pain‐related symptoms, poorer physical function, and are less physically active. To promote patient empowerment in rehabilitation interventions it is important to identify and support self‐management.

Ethics of Home Monitoring During the Corona Crisis: Promoting Patient Empowerment? Lessons from the Pandemic

"The development and use of home monitoring or remote patient monitoring has rapidly evolved due to scaling down of face-to-face patient care during the corona pandemic. Home monitoring systems for Covid-19 as well as for other conditions are proliferating. One of the stated goals of home monitoring systems is to promote patient empowerment. However, this concept is hardly well defined and often used in a rhetorical way. In this presentation, we will discuss the findings of our empirical study into the views of patients, healthcare professionals and policy makers regarding patient empowerment. We report on the results of two case studies of home monitoring systems in the Netherlands implemented during the corona crisis, in which we study, first, what patients, healthcare professionals and policy makers understand patient empowerment to be, and second, whether they think patient empowerment is actually promoted in these contexts. Finally, we will describe different interpretations or degrees of patient empowerment – compliant, concordant, and collaborative - and normatively argue for home monitoring systems that promote optimal patient empowerment. "

Commonly used immunosuppressive drugs for kidney diseases and pregnancy: focus on open questions

ABSTRACT Pregnancy is still a challenge in women with autoimmune diseases or kidney transplantation. In this context, management of the immunosuppressive therapy is critical, but, in spite of more than 60 years of experience, many issues remain open, also because of the difficulty in disentangling, in complex patients, the effect of the disease and of the frequent multiple treatments. For this purpose, we have tried to synthesize the existing knowledge and the unresolved issues, to support counseling and promote patient empowerment.