Providing Patient Education Research Articles

P1082Validation of cardiologist-created, audiovisual education delivered via smart devices while awaiting outpatient consultation: optimising atrial fibrillation management through shared decision making

Abstract Background Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and its management requires numerous complex decisions shared between patients and their treating cardiologist. However, apart from the restricted time within each consultation, there is limited opportunity to educate patients for optimising the shared decision making that can subsequently impact the effectiveness of their management. A relatively untested opportunity for education is while patients are awaiting cardiology outpatient consultation. This could be in part due to the lack of availability of educational material that is suitable for both patient management and satisfaction, or that the development process is often too time or resource-heavy for the respective cardiologist. Audiovisual educational material created by the cardiologist could potentially be better received by patients while awaiting outpatient consultation. Purpose To evaluate the effectiveness and efficiency of a cardiologist-created, audiovisual educational module in facilitating shared decision making for the management of AF. Methods The cardiologist developed 4 educational videos on AF that aimed to enhance patient knowledge for the following topics: (1) What is AF?, (2) AF Management, (3) Stroke risk and anticoagulation, and (4) Lifestyle modification. The videos were then combined into a web-based audiovisual module where they were viewed sequentially and accompanied by questions gauging patient experience. The module was delivered using Quick Response (QR) code scanning on smart devices to 115 patients with AF in the waiting room prior to cardiologist consultation. Feedback was recorded on 5-point Likert Scales or Visual Analogue Scales (VAS). Results Each video took an average of 3 minutes and 42 seconds for the cardiologist to record using minimal resources comprising of a smart device and a desktop computer for the cardiologist-narrated audiovisual presentation. On the Likert scales, 96.4% of responders were "very satisfied" with the individual videos, with only 0.8% of responses conveying dissatisfaction. The VAS ratings (0-100) were: Improving peri-consultation anxiety 89.93 +/- 9.62; Improving the patient’s decision making 85.86 +/- 16.71; Improving likelihood of long-term treatment adherence 87.30 +/- 12.27; Beneficial effect on patient experience from the cardiologist’s narration in the educational module 86.51 +/- 14.86. Conclusions The audiovisual educational module was created by the cardiologist in a time and resource-efficient manner. Patients responded positively to both the cardiologist’s narration and the content of the AF-specific videos. This approach was not only a beneficial utilisation of the patient’s waiting time prior to outpatient consultation, but also a simple, time and resource-efficient way that cardiologists themselves can provide patient education, and by extension optimise shared decision making in the management of AF.

116-LB: Evaluating the Impact of Glucommander on Improvement in Time-in-Range (TIR) in Type 2 Diabetes Using Continuous Glucose Monitoring

A proof of concept single center prospective study aimed at evaluating the safety and efficacy of utilizing Glucommander outpatient insulin dosing software to assist providers in titrating basal bolus insulin doses, using Abbott Freestyle Libre 14-day glucose monitoring system. A total of 25 adults (18-80), having T2D and an A1C > 8%, were enrolled. A nurse educator provided patient education on insulin administration, meal planning and use of the glucose sensor. Baseline CGM data was collected during week 1, after which time participants insulin doses were titrated weekly for the next 4 weeks. Data was collected on initial HbA1C, days of CGM wear, time in range (TIR), and time in hypoglycemia. Use of Glucommander significantly improved TIR from a baseline of 48.02% during the initial week to 73.84% during the final week of treatment (p<0.00001). Time in hypoglycemia (BG < 54 mg/dl) decreased from 0.37% during the initial week to 0.33% during the final week of treatment (p>0.557). % Changes in insulin: %Change(Basal) = 10.5%, %Change(Total Boluses)= 19.7%, %Change(TDD)= 15.1%. Disclosure B.W. Bode: Advisory Panel; Self; Medtronic, Novo Nordisk A/S. Consultant; Self; Eli Lilly and Company, Medtronic, Novo Nordisk A/S. Research Support; Self; Abbott, Advance, Boehringer Ingelheim Pharmaceuticals, Inc., Dexcom, Inc., Diasome Pharmaceuticals, Inc., Eli Lilly and Company, Insulet Corporation, Janssen Pharmaceuticals, Inc., MannKind Corporation, Medtronic, National Institutes of Health, Nova Biomedical, Novo Nordisk A/S, Provention Bio, Inc., Sanofi, Senseonics. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., MannKind Corporation, Medtronic, Novo Nordisk A/S, Sanofi, Senseonics. Stock/Shareholder; Self; Aseko. J.G. Clarke: Employee; Self; Glytec. Stock/Shareholder; Self; Glytec. Funding Glytec, LLC

0737 Diagnostic Value And Financial Effects Of Recertification Polysomnography In Medicare Patients With Obstructive Sleep Apnea

Abstract Introduction The annual cost of diagnosis and treatment of obstructive sleep apnea (OSA) exceeds 12.4 billion dollars in the United States. The Centers for Medicare and Medicaid Services (CMS) require that after initiation of positive airway pressure (PAP) therapy patients have physician follow up and comply with specific requirements. Otherwise, continued PAP benefits are terminated and patients must undergo repeat sleep testing to reinstate therapy. Repeat testing can become an economic burden. We hypothesize that restudying patients prior to reinstating PAP therapy does not change the diagnosis and may only result in increased health care costs. Methods A chart review of polysomnographic studies (PSG) was performed on Medicare referrals made for the purposes of recertification to the Memorial Hermann Sleep center between October 2018 and 2019. Demographic and diagnostic data (including AHI) were collected. The percentage of patients with a change of diagnosis between the initial study and the recertification study was documented. Results 429 Medicare patients were referred for polysomnography. 34 patients were referred for PAP recertification. The average age in the recertification group was 65 years, 47% were male with an average BMI of 33.4 kg/m2. The average AHI on the recertification study was 33.5 events/hour (range 7-114). None of the patients sent for PAP recertification by polysomnography had a negative study for OSA. Conclusion Repeat PSG did not change the need for PAP therapy in patients originally diagnosed with OSA (all the patients continued to qualify). The mandatory referral of all patients who do not meet the CMS requirements for continued benefits for PAP, represents an extra cost to the health care system without a change in the clinical therapy. This money may better be utilized in providing patient education known to improve adherence to PAP. Support N/A

Development and Implementation of Public Awareness Campaigns around Breast Cancer in the UAE: A Ras Al Khaimah Case Study

Breast cancer is the leading cause of cancer deaths in the United Arab Emirates (UAE), and is the country’s most common cancer in females. Currently, participation of UAE-based women in breast cancer screenings remains low, with women diagnosed at advanced stages, negatively impacting disease prognosis and survival rates. Early detection would enable more treatment options, improve the conditions of survivorship, and reduce the number of premature deaths. Health awareness campaigns and screening services need to address the barriers that are preventing women in the UAE from having early screenings and apply targeted methods of encouraging the participation of both Emirati and non-Emirati women. This policy paper explores women’s use of breast cancer screening practices and other women’s health services in the UAE, as well as the emirate’s ecosystem of awareness building and support impacting their behaviors. This includes the current encouragement and outreach strategies and campaigns being utilized, the knowledge levels of health professionals on breast screening practices, and how organizations and institutions provide patient education. Using the perspectives of women, nurses, and representatives from health organizations, the policy paper concludes with recommendations for effective breast cancer public campaigns and improved breast screening participation.

Patterns in progression from early stage melanoma to late stage melanoma: Implications for survivorship follow up.

e24055 Background: Despite an encouraging 99% five-year survival in patients diagnosed with early-stage melanoma, a higher proportion of fatal melanomas initially present with thin ( < 1mm) rather than thick ( > 4mm) melanoma.1 Therefore, early-stage melanoma survivorship remains a topic of high interest. We examined a cohort of early-stage melanomas which progressed to stage IV to inform survivorship and risk-stratification approaches in this large, understudied population. Methods: From a retrospective single-center study of 880 consecutive melanoma patients from 2016-2020, we identified new, non- de novo diagnoses of stage IV melanoma which progressed from an initial early-stage (IA-IIA) diagnosis. Descriptive data were collected via chart review on demographics, clinical features, presentation at time of progression, and follow up prior to progression. Results: A total of 50 patients met the inclusion criterion of an initial stage IA-IIA diagnosis with subsequent progression to stage IV melanoma. Primary early stage melanomas were diagnosed an average of 6.1 years prior to metastatic disease progression, with 46% (n = 23) diagnosed within 3 years, 22% (n = 11) between 4-6 years, 12% (n = 6) between 7-10 years, 8% (n = 4) between 10-12 years, and 12% (n = 6) beyond the 12 year mark from their initial early-stage diagnosis. Average age at time of diagnosis was 57.7 (median 60, range 21-68), and 62% (n = 31) were male. The two most common early-stage diagnostic sites were lower extremities (27.5%, n = 14) and back (23.5%, n = 12). The two most common sites of metastatic disease were lung (46%, n = 23) and brain (28%, n = 14). A total of 30% (n = 15) and 34% (n = 17) of this cohort maintained follow up with oncology and dermatology, respectively, prior to their stage IV diagnosis. Symptomatic disease lead to 80% (n = 40) of stage IV diagnoses, while 14% (n = 7) were diagnosed through routine oncologic or dermatologic follow up, and the final 6% were diagnosed incidentally. Conclusions: Early stage melanoma patients who develop stage IV disease exhibit wide ranges in onset of disease progression, thus survivorship plans for this group could include a combination of early provider screening and patient education for later presentations of metastatic disease. Due to relatively common metastatic involvement of the lung and brain, a high suspicion to screen for metastatic disease with symptoms involving these organs may be appropriate.

MHealth for breast cancer patient navigation: What patients want—What clinicians need.

e19244 Background: mHealth interventions support patient behavior change, promote adherence to treatment provide patient education, and clinical decision support. Research on mHealth interventions has focused on unidirectional communication from providers to patients. mHealth to support patient navigation through multidisciplinary breast cancer care (MBCC) has not been realized. Our team explored the information needs and perceived benefits and barriers to the design and adoption of mHealth solutions to support patient-centered MBCC. Methods: We conducted a prospective cohort study with patients and family members of patients with breast cancer (Stage 0-III), clinicians and practice staff participated semi-structured interviews/focus group to explore stakeholder perceptions of mHealth across the domains of: information needs, communication, technology preferences, and barriers and facilitators to adoption and implementation. Transcripts were analyzed using concurrent content analysis and recruitment continued until saturation of themes was achieved within each stakeholder group. Results: We conducted 22 interviews and 5 focus groups with 49 participants generating 466 individual responses. Patients, clinicians, and staff found existing communication pathways (e.g., calls to office, patient portal) sufficient in meeting patient’s needs. Family members and caregivers saw the potential of mHealth as beneficial to decision-making and treatment adherence. Patient access to health information on a smartphone between visits was perceived positive to support care organization. Clinicians and staff recognized the need for patient engagement to optimize treatment outcomes. Concerns about workload, privacy and security, and misinterpretation of information shared in mHealth apps were perceived as barriers to adoption. Recommendations included EHR integration, existing “in-box” management workflow, and team engagement in information management processes. Conclusions: mHealth can play a pivotal role in supporting patient-clinician-family dynamics for MBCC. Designers of mHealth should carefully consider the relative value of applications to the clinical workflow, patient and family needs, and identify team-based approaches to supporting adoption and implementation.

Using an online learning module to teach nursing students about food insecurity as a social determinant of health

Currently, food insecurity is a lack of access to enough food for a healthy life that impacts approximately 40 million Americans and 821 million people worldwide. These statistics are expected to rise as a result of the COVID-19 pandemic drastically. Studies show that healthcare and nursing curricula are currently deficient in providing education to help healthcare providers combat food security and provide patient education. The purpose of this article is to discuss a curricular framework that can be implemented in both nursing and healthcare curricula to offer appropriate training for food insecurity assessment, care, and patient education.

Learning What I Need to Know: Experiences of Rural Cardiac Surgery Patients

Purpose: This hermeneutic study expands understandings of rural cardiac surgery patients’ experiences of their learning needs following cardiac surgery to inform the provision of patient education for this population. Sample: Eighteen rural residents provided accounts about their experiences. Findings: An interpretation as analysis approach revealed three themes: a) Learning: Family History Informing Preventive Care; b) Learning: The Notebook, Blue’s Clues, and Explanations; and c) Learning: Lifestyle Changes and Confronting Mortality. Conclusions: The first theme demonstrates needs to ensure patients from rural settings understand that preventing cardiovascular disease is not limited to family members’ experiences with secondary and tertiary prevention. The second theme underscores the importance of providing patient education materials that are readable and useable, and considers existential learning needs. The last theme highlights the importance of patients understanding how lifestyle changes involve embracing new ways of living that are enhanced through cardiac rehabilitation, and yet, can be experienced as life limiting.  DOI:  http://dx.doi.org/10.14574/ojrnhc.v20i1.605

Teaching Versus Learning

Teaching Versus Learning

P74 Group counselling: a holistic care model

Abstract Background Disease modifying anti rheumatic drugs (DMARDs) play a vital role in controlling autoimmune disease. They are complex medications requiring nurse counselling to initiate. Staff vacancies and increasing referrals led to 12-week waiting times from decision to treat in our Trust. We wanted to improve the efficiency of the medication counselling process, but at the same time use it as an opportunity to educate our patients on their disease, management and self-care. Methods We designed and delivered a successful group clinic to improve patient experience, reduce waiting times and improve efficiency. As well as covering the necessary DMARD information, the clinic includes patient education on general, physical and mental well-being, dietary advice as well as physiotherapy and occupational therapy input. The clinic format consists of a presentation/discussion, peer support and individual consultation, providing truly holistic care. Results Waiting times: reduction from 84 days to 7-14 days from decision to treat for our two main DMARDS and 56 days to 14 days for our anti TNF therapies. Clinical outcome/patient safety: Earlier initiation of DMARDs has been shown to reduce morbidity. Financial: Additional £444 income per clinic (compared with previous clinic process) at a tariff of £111 per patient. Group clinics currently run weekly. Patient feedback: 50 patient feedback forms have been collected and reviewed. Of these 50 patients 97.8% of questions asked were marked as agree or strongly agree to a positive experience. Shared learning: The clinic format was presented at a regional meeting and at our Trusts Quality Improvement Day. There is interest in adopting a similar approach in other departments in the Trust and in other rheumatology departments in the region. Conclusion Our group consultation model provides a holistic model to care that has been very popular with our patients. We have subjectively had an increase uptake in physiotherapy services and patients seem to be persevering and tolerating their medications better. Our group consultations have been running successfully for a year, and we have expanded the sessions to cover more drugs including our anti TNF therapies. It is yet early days to comment on the long-term impact our clinic has on patients, but with our clinic providing patient education and empowering patients through self management we are hopeful that we will be improving the long-term outcome of our patients. Disclosures K. Nadesalingam None. C. Short None.

Attributable risk of all-cause mortality in hypertensive adults based on disease risk prediction model: A Chinese cohort study

BackgroundThe aim of this study was to estimate the attributable risk for all-cause mortality in hypertensive adults living in Beijing, China. MethodsWe conducted a prospective cohort study on the basis of the disease risk prediction model, which included 3006 hypertensive patients aged 50 and over who participated in the annual health examination from thirty-eight community health centers were randomly selected from all 53 community health centers in Dongcheng district of Beijing in China. This cohort study was conducted from January 1, 2013 to June 31, 2018 in these community health centers. Data included age, gender, education level, BMI, smoking and drinking status, renal function, diabetes mellitus (DM), coronary heart disease, levels of blood pressure, use of medications, and blood lipid levels. Resultsthe follow-up time was 4.90±0.51 years. There were significant survival differences by gender, renal function (eGFR>90 vs. 60–90 vs. <60mL/min per 1.73m2), smoking (smoking vs. No smoking), hypertension severity (SBP≥140 or DBP≥r vs. SBP/DBP<140/90mmHg), education level (<6 vs. 6–12 vs. >12 years), coronary heart disease (CHD) (CHD vs. NO CHD). In the multivariate Cox proportional hazard analysis, the prognostic factors of all-cause mortality in hypertensive patients were male [HR 1.662, 95% CI 1.110–2.489, p=0.014], educational level<6 years [HR 2.044, 95% CI 1.164–3.591, p 0.013], age ≥65 years [HR 3.092, 95% CI 1.717–5.571, p<0.001], smoking [HR 1.885, 95% CI 1.170–3.309, p=0.009], eGFR<60mL/min per 1.73m2 [HR 3.591, 95% CI 2.023–6.371, p<0.001]. Conclusionswe conclude that decreasing eGFR, increasing age, smoking, low education and gender (male) are significant and independent risk factor for mortality in hypertension for this urban cohort. Recommendations may include protecting renal function, providing patient education, and cessation of smoking. It highlights that early preventive measures are needed to detect kidney impairment and protect renal function. It also suggests that earlier smoking cessation may be important for hypertensive patients.

Use of a virtual patient simulation program to enhance the physical assessment and medical history taking skills of doctor of pharmacy students

IntroductionTo evaluate if utilizing a virtual simulated patient program in a required pharmacy course improves the health history taking and physical assessment skills of first-year professional pharmacy students. MethodsDuring a 14-week course students registered for a web-based virtual patient simulation program. Students were assigned a virtual patient case to complete during weeks one and 13 of the course. Scores from the pre- and post-interventions were compared focusing on the students' ability to perform a physical exam, take a medical history, provide patient education, and display empathy. Students were also asked to self-assess their skills after having been exposed to the virtual simulation program throughout the semester. ResultsThe total number of paired observations used in the final analysis of the pre- and post-virtual patient test case was 171 students. The overall student performance index, which includes the scoring of subjective/objective data and patient education/empathy, improved from 52% at week one to 78.42% at week 14. The individual scoring of subjective/objective data and patient education/empathy significantly improved from week one to week 13. Approximately 76.54% of the class strongly agreed or agreed that the virtual simulation program made them feel more confident in their ability to obtain a medical history from patients. ConclusionsVirtual patient simulation programs are effective teaching methods for students to develop and improve upon their medical history taking and physical assessment skills.

Pharmacist impact on pneumococcal polysaccharide vaccination rates in patients with diabetes in a national grocery chain pharmacy

ObjectivesTo evaluate the impact of pharmacist education and intervention on pneumococcal polysaccharide (PPSV23) vaccination rates in patients with diabetes in a national grocery chain pharmacy and assess patient awareness and barriers to receiving the PPSV23 vaccine. MethodsProspective interventional 4-month study in 3 grocery chain pharmacies targeted patients aged between 19 years and 64 years who filled a medication for diabetes 90 days before the study period. Immunization status was verified with pharmacy records and the Virginia Immunization Information System. A note was added to the profile of patients who did not have a record of PPSV23 immunization to alert the pharmacist to provide patient education about the vaccine the next time the patient presented to the pharmacy. Patients who received education either accepted or declined the recommendation for the vaccine and completed a voluntary survey assessing awareness and barriers to receiving the vaccine. Vaccination rates were calculated before and after pharmacist intervention. ResultsPharmacists provided education to 126 out of the 321 patients potentially eligible to receive the vaccine. For patients receiving the intervention, 51 patients were excluded, 7 patients refused the survey, and 68 patients completed the survey. Twelve patients accepted the pharmacist’s recommendation to receive the vaccine. Of patients who completed the survey, 83.6% had type 2 diabetes, 61.8% were men, 77.9% were Caucasian, and the mean age was 51.5 years. More than one-half of the patients (54%) were not aware of the recommendation to receive the PPSV23 vaccine, and 46% of patients wanted to discuss it with their primary care provider. The PPSV23 vaccination rate was 28.6% before pharmacist education and increased to 31.8% after intervention. ConclusionPharmacist education increased PPSV23 vaccination rates at the pharmacy, and the primary barrier identified for patients receiving the vaccine was that the patients wanted to discuss the recommendation with their provider.

Collegiate and Professional Ice Hockey Athletic Trainers’ Hydration Practices and Knowledge: Part 1

Despite cool environments, ice hockey athletes are predisposed to hypohydration due to extensive equipment, high intensity activity, and high sweat rates. The purpose of this study was to determine hydration practices and awareness of fluid recommendations among athletic trainers (ATs) working with NCAA Division I, NCAA Division III, and professional ice hockey teams. Most professional ATs (90.1%) utilized at least one hydration status measure, while 61.7% of collegiate ATs did not measure hydration. Compared to Division I, more Division III ATs did not have electrolyte supplements (p &lt; .001) and believed they did not have adequate access through budget/sponsorship (p &lt; .001). Both professional (72.0%) and collegiate (53%) ATs reported athletes had open access to electrolyte supplements or gave them to any athlete who asked. Athletic trainers provided patient education and had fluids accessible to athletes. Areas to improve clinical practice include monitoring electrolyte supplement access and collegiate ATs assessing hydration status.

Medication Adherence in Patients with Systemic Lupus Erythematosus : A Descriptive Study

Background and objectives: Systemic lupus erythematosus is an autoimmune disease that involves several systems of the body. Due to the chronic nature of this disease, non-adherence with medication regimen can lead to deterioration of the disease and also misinterpretation of treatment results. The aim of this study was to determine the medication adherence of patients with Systemic lupus erythematosus.Method: In this descriptive study, medication adherence was investigated in 209 patients with SLE who were attending lupus clinic of one of the hospitals affiliated to Tehran University of Medical Sciences. The samples who had the inclusion criteria were entered into the study in a convenience and continuous manner. Then, they completed a demographic information form and MMAS-8. Data were analyzed by SPSS software using descriptive statistics, chi-square and ANOVA tests.Results: The results showed that 18.7% of patients had high adherence to medication regimen, so that 94 patients (45.0%) had low adherence and 76 patients (36.4%) had moderate level of adherence to medication. Also, there was no significant relationship between the demographic and clinical variables of patients and their medication adherence.Conclusion: Due to the low and moderate medication adherence of patients with Systemic lupus erythematosus, it is necessary to take measures to increase the medication adherence among these patients. It is also necessary to provide patient education by nurses and physicians in the clinic and to pay attention to this issue in medical and nursing programs.

Chronic diarrhoea due to bile salt malabsorption: nurse-led assessment, medical treatment and dietary management

Bile salt malabsorption (BSM) occurs when bile salts, which are secreted in the small bowel to aid digestion of fats and vitamins, are not sufficiently re-absorbed in the terminal ileum. Consequently, an excess of bile salts enters the colon, causing chronic explosive diarrhoea, associated with abdominal cramps, flatulence and urgent, frequent and unpredictable bowel habits. BSM affects around 1% of the population, often occuring in ileal Crohn's disease or after ileal resection. Diagnosis begins with a nurse-led assessment, including blood and stool tests, to exclude other potential organic causes of chronic diarrhoea. BSM can then be confirmed and classified with a 75Se-homocholic acid taurine (SeHCAT) scan. BSM can be treated medically with bile salt sequestrants, including colestyramine sachets, which are approved but have an unpleasant taste, and colesevelam tablets, which are more tolerable but more expensive and not yet approved. However, long-term sequestrant use can impact absorption of vitamins and other medications. BSM can also be managed with a low-fat diet, which is cost-effective and can reduce the amount of bile secreted. Nurses should provide patient education to ensure adherence and safe use.

Chronic Care for Attention-Deficit/Hyperactivity Disorder: Clinical Management from Childhood Through Adolescence.

Impairments generally persist when children diagnosed with attention-deficit/hyperactivity disorder (ADHD) mature into adolescence. To examine changes in ADHD care during the transition from childhood to adolescence, we conducted a retrospective, longitudinal cohort study of patients diagnosed with ADHD before the age of 10 years to assess changes from preadolescence through adolescence in (1) frequency by which primary care providers offer ADHD care to patients, (2) range of concerns assessed during patient encounters, and (3) treatments implemented or recommended. We identified patients from 3 practices included in a large primary care network who (1) were born between 1996 and 1997, (2) were diagnosed with ADHD before the age of 10 years, and (3) received primary care continuously from age 9 through late adolescence. Clinical care was compared among patients in preadolescence (age 9-11), early adolescence (age 12-14), and late adolescence (age 15-18). Children diagnosed with ADHD before the age of 10 years were less likely to have a documented visit for ADHD during late adolescence (41% of patients) compared with preadolescence (63%, p < 0.001). Evidence of monitoring for depression, suicide, and substance abuse increased from preadolescence to adolescence (p < 0.001) and occurred in about 90% of adolescent patients. However, monitoring for risky sexual activity occurred in only about 50% of adolescents. Discussions of medication diversion and driver readiness were essentially not documented. The findings raise concerns about how primary care providers manage adolescents with a history of ADHD. Improving monitoring of risky sexual behavior and driver readiness and providing patient education about medication diversion are needed.

Using mobile phones to improve community health workers performance in low-and-middle-income countries

BackgroundIn low-and-middle-income countries community health workers are the core component of the PHC system as they act as a liaison between the communities and the healthcare facilities. Evidence suggests that the services offered by these workers have helped in the decline of maternal and child morbidity and mortality rates and the burden of communicable and non-communicable diseases. However, the coverage and the overall progress towards achieving the SDG targets is very sluggish. The recent consensus concerning this current pace of progress, is that it relates to financial and human resources constraints. CHWs are overburdened as they are expected to accomplish more although they may not obtain the required support to perform their duties. The health systems of LMICs, have given very little attention to the work environment of CHWs; which has negatively affected CHWs productivity, and quality of services. This debate is intended to explore the potential of mobile phone technology in LMICs for improving CHWs performance and effectiveness.DiscussionTo improve CHWs productivity, some studies involved the use of mobile phones for data collection and reporting, while other studies used mobile technology for patient to provider communication, patient education, CHWs supervision, and monitoring and evaluation. A wide range of benefits exists for using mobile phones including reduction in CHWs workload, improvement in data collection, reporting and monitoring, provision of quality healthcare services, supportive supervision, better organization of CHWs tasks and improvement in community health outcomes. However, a number of studies suggests that CHWs encounter unique challenges when adopting and using mobile health solutions for health service delivery such as, lack of CHWs training on new mHealth solutions, weak technical support, issues of internet connectivity and other administrative challenges. Future research efforts should be directed to explore health system readiness for adopting sustainable mHealth solutions to improve CHWs workflows in LMICs.ConclusionFuture research efforts and policy dialogue should be directed to explore health system readiness for adopting sustainable mHealth solutions to improve CHWs workflows in LMICs.

Implementation of a medication education training program for student pharmacists employed within an academic medical center.

To describe the implementation of a student pharmacist medication education training program (the REWARDS Method), to determine if training was effective in preparing employed student pharmacists to provide medication education, and to assess medication education completion rates. Hospital readmissions are often attributable to poor transitions of care (TOC), and medication education prior to discharge may improve TOC. To expand upon existing medication education efforts, the Johns Hopkins Hospital Adult Inpatient Pharmacy (AIP) designed and implemented the REWARDS Method, a training program to prepare employed second- and third-year student pharmacists to provide medication education. The REWARDS Method includes 6 distinct steps, which incorporate student self-directed and pharmacist-facilitated learning. Students were trained to provide patient education targeting 4 classes of high-risk medications (anticoagulants, inhalers, insulin, and naloxone) on multiple inpatient units served by the AIP. A total of 43 hours of pharmacist time was needed to complete training for the 10 employed student pharmacists. A survey was used to assess preparedness for completing medication education. Survey responses indicated that participants were sufficiently to exceedingly prepared to perform medication education. The division's completion rate for patients requiring education was 79% in 2017, compared to 86% in 2018 (p = 0.006). The REWARDS Method is an effective training program that successfully incorporated employed student pharmacists into medication education efforts. Our study demonstrated high rates of students successfully completing training and an increase in the rate of patient education completion.

Management of Acute Idiopathic (Viral) Pericarditis in the Emergency Department: A Review for the Nursing Professional.

Acute pericarditis is an inflammatory disorder that contributes to chest pain admissions in the emergency department (ED). Nursing professionals can play a vital role in the differential, triage and management of acute pericarditis in the ED. First-line pharmacotherapy to specifically treat acute pericarditis of viral or idiopathic origin is paramount in improving patients' quality of life and reducing the risk of further recurrences of pericarditis and consists of combination therapy with aspirin (acetylsalicylic acid [ASA]) or a nonsteroidal anti-inflammatory drug (NSAID), in combination with colchicine. Corticosteroids should not be initiated as first-line therapy in idiopathic (viral) pericarditis, as they increase the risk of recurrences. Nursing professionals are also pivotal in monitoring pharmacotherapy with respect to safety and efficacy. Overall, the nursing professional can facilitate timely administration and monitoring of medications, provide patient education, promote adherence, and assist in transitions of care for patients diagnosed with acute idiopathic (viral) pericarditis in the ED.