Strong Patient-provider Relationship Research Articles

Factors Associated with Loss to Follow-Up in Pediatric Concussion Patients after Initial Visit: A Retrospective Study at a Concussion Clinic

ObjectiveThe objective of this retrospective study is to identify factors associated with loss to follow-up for post-concussion clearance in pediatric patients by comparing loss to follow-up and full clearance patients. MethodsThis retrospective single-center cohort study analyzed 140 consecutive patients at a pediatric concussion clinic of a safety-net hospital for loss to follow-up, defined as not achieving clearance at last appointment. Univariate and multivariate regression models were fit on variables of interest, including demographic, mechanism and severity of concussion, and characteristics of the first evaluation post-concussion and follow-up management. ResultsOf the sample, 40% (n=56) achieved clearance and 60% (n=84) were lost to follow-up. Median age was 15 (IQR 11-17), with male predominance (60.7%). Living with a biological parent (OR =0.145, 95% CI =0.028-0.760) and sports involvement (OR =0.256, 95% CI =0.092-0.764) were protective factors, while being 10 years old or older (OR = 13.466, 95% CI = 2.792-64.958) and attending 2 or fewer follow-up appointments (OR = 19.027, 95% CI = 4.991-72.533) were risk factors for loss to follow-up. No significant differences were found between sex, race, driving distance, type of insurance, and mechanism of injury. ConclusionLiving with a biological parent and involvement in sports showed to be protective factors for loss to follow-up. Age at time of concussion and number of appointments were risk factors. A “golden window” of two appointments was identified, highlighting the need of a strong rapport and engagement in shared decision making. Future directions include prospective studies implementing strategies targeting adolescents and building a strong patient-provider relationship.

Exploring geriatric trauma unit experiences through patients’ eyes: a qualitative study

IntroductionThe surgical management of older patients is complex due to age-related underlying comorbidities and decreased physiological reserves. Comanaged care models, such as the Geriatric Trauma Unit, are proven effective in treating the complex needs of patients with fall-related injuries. While patient-centered care is an important feature of these comanaged care models, there has been minimal research dedicated to investigating the patient experience within Geriatric Trauma Units. Therefore, it remains uncertain whether the Geriatric Trauma Unit’s emphasis on a patient-centered approach truly manifests in these interactions. This study explores how patients with fall-related injuries admitted to a Geriatric Trauma Unit perceive and experience patient-centered care during hospitalization.MethodsThis qualitative generic study was conducted in three teaching hospitals that integrated the principles of comanaged care in trauma care for older patients. Between January 2021 and May 2022, 21 patients were interviewed.ResultsThe findings highlight the formidable challenges that older patients encounter during their treatment for fall-related injuries, which often signify a loss of independence and personal autonomy. The findings revealed a gap in the consistent and continuous implementation of patient-centered care, with many healthcare professionals still viewing patients mainly through the lens of their injuries, rather than as individuals with distinct healthcare needs. Although focusing on fracture-specific care and physical rehabilitation aligns with some patient preferences, overlooking broader needs undermines the comprehensive approach to care in the Geriatric Trauma Unit.ConclusionEffective patient-centered care in Geriatric Trauma Units requires full adherence to its core elements: patient engagement, strong patient-provider relationships, and a patient-focused environment. This study shows that deviations from these principles can undermine care, emphasizing the need for a holistic approach that extends beyond treating immediate medical conditions.

A Systematic Review: Impact of Nurse Led Clinics on Scope, Feasibility and Cost Effectiveness

The majority of NLCs are managed autonomously by nurses, with the assistance of a multidisciplinary team with advanced training and expertise. In these clinics, nurses perform thorough physiological assessments, arrange the patient's care accordingly, administer therapies, monitor the patient's condition, administer medication, educate patients about their health, and refer patients to other colleagues as needed. The purpose of this systematic study was to determine the extent, viability, and cost-effectiveness of nurse-led clinics. The review's goal is to give the best available data on nurse-led clinics so that it may assess if adopting NLCs with a standardized structure is necessary to deliver rigorous treatment and support future attempts to establish nurse-led clinical services. A literature search was conducted using electronic databases such as Medline, Pubmed, Pubmed Central, CINAHL, and Google Scholar to gather information on the impact of Nurse-Led Clinics with respect to scope, feasibility, and cost effectiveness. The search was conducted in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Two standards were used to evaluate the 117 articles that were found in the search results. First, papers that have been published and are readily available for peer review should be considered substantial information. Second, studies that focused just on the effects of NLC in respect to scope, practicability, and affordability. Studies on the breadth, viability, and cost-effectiveness of NLC were included in the search, whereas research publications published in languages other than English were disregarded. Following screening and the removal of duplicates, 13 papers were found to be eligible, and 10 studies were included in this review. The analysis indicates that access to healthcare has improved dramatically in nurse-led clinics across many specialized areas. Because NLCs are easily accessible, primary care settings are not as burdened and fewer needless emergency visits occur. Strong patient-provider relationships are fostered by nurses' all-encompassing, patient-centered approaches, which raise patient satisfaction and engagement in the healthcare process. The focus of effective nurse-led clinics is on interprofessional treatment and teamwork. Cooperation amongst nurses, doctors, pharmacists, and other medical professionals promotes collaborative decision-making, coordinated treatment, and better patient outcomes. The collaborative model, in which nurses play a crucial role as care coordinators, guarantees that patients receive thorough and seamless care.

Knowledge, attitudes and beliefs toward polypharmacy among older people attending Family Medicine Clinic, Nairobi, Kenya

BackgroundLife expectancy has increased over the last century among older people, particularly those aged over 60 years. Aging is associated with increased disability, multiple chronic conditions, and increased use of health services managed with polypharmacy. There are few studies on polypharmacy and aging in sub-Saharan Africa, and it is unclear what older people know and their attitudes toward polypharmacy. This paper presents findings from a study that aimed to understand older people’s knowledge, attitudes and beliefs about polypharmacy.MethodsA qualitative study using in-depth interviews of 15 patients aged 60 years and older who were taking more than five medications per day. The study was conducted at the Family Medicine Clinic (FMC), Aga Khan University Hospital, Nairobi. Data were analyzed using NVivo 12 software.ResultMajority of participants had a good understanding of their underlying health conditions, but they did not know the specific names of the medications they were taking. Participants had diverse attitudes toward polypharmacy, with both positive and negative perceptions. Although adverse side effects were reported, participants remained positive because they believed these medicines were beneficial. Religion, faith and living healthy lifestyles were perceived to contribute to their positive attitude toward polypharmacy. Stigma and the cost of medication were reported as barriers.ConclusionThis study provides valuable insights into the complexities of polypharmacy in older people. It highlights the importance of patient education, fostering strong patient-provider relationships, de-stigmatization, and improving medication affordability and accessibility. Further research could explore the polypharmacy of older people attending public institutions in rural Kenya.

Primary Care Providers' Experiences Treating Opioid Use Disorder Using Telehealth in the Height of the COVID-19 Pandemic.

The COVID-19 pandemic catalyzed a rapid shift in healthcare delivery towards telehealth services, impacting patient care, including opioid use disorder (OUD) treatment. Regulatory changes eliminated the in-person evaluation requirement for buprenorphine treatment, encouraging adoption of telehealth. This study focused on understanding experiences of primary care providers in predominantly rural areas who used telehealth for OUD treatment during the pandemic. Semi-structured interviews were conducted with 22 primary care providers. Participants practiced in 13 rural and 9 urban counties in Kentucky and Arkansas. Data were analyzed using conventional content analysis. The pandemic significantly impacted healthcare delivery. While telehealth was integrated for behavioral health counseling, in-person visits remained crucial, especially for urine drug screenings. Telehealth experiences varied, with some facing technology issues, while others found it efficient. Telehealth proved valuable for behavioral health counseling and sustaining relationships with established patients. Patients with OUD faced unique challenges, including housing, internet, transportation, and counseling needs. Stigma surrounding OUD affected clinical relationships. Building strong patient-provider relationships emerged as a central theme, emphasizing the value of face-to-face interactions. Regarding buprenorphine training, most found waiver training helpful but lacked formal education. This research offers vital guidance for improving OUD treatment services, especially in rural areas during crises like the COVID-19 pandemic. It highlights telehealth's value as a tool while acknowledging its limitations. The study underscores the significance of strong patient-provider relationships, the importance of reducing stigma, and the potential for training programs to elevate quality of care in OUD treatment.

The Effect of Patient Relationship Management on Patient Loyalty in Buea, Cameroon: Mediating Role of Patient Satisfaction

Patient Relationship Management (PRM) has emerged as a pivotal strategy within the healthcare sector, aiming to cultivate strong patient-provider relationships and bolster patient satisfaction. This study investigates the influence of PRM on patient loyalty, with a focus on patient satisfaction as a mediating factor. The research delves into established literature and a theoretical framework to elucidate the interconnectedness between the constructs. Through convenience sampling method and data collected from patients who had received medical attention from hospitals operating in Buea, Cameroon, this study offers empirical insights into the critical determinants of patient loyalty in the healthcare industry. Data was drawn from 371 patients in the study area. PRM was found to positively impact patient loyalty. PRM had a significant effect on patient satisfaction and patient satisfaction positively impacted patient loyalty. Furthermore, patient satisfaction was found to partially mediate the relationship between PRM and patient loyalty. Understanding the nuanced relationship between PRM, patient satisfaction, and patient loyalty is vital for healthcare organizations seeking to enhance service quality and foster long-term relationships with their patients through personalised communication, targeted service delivery, and proactive patient engagement.

Abstract A060: “If it’s something that I can do for my future generations…”: Using multiple qualitative methods to inform an intervention to promote shared decision making and participation in clinical trials among Black women diagnosed with breast cancer

Abstract Background: Black women are more likely to present with advanced stage disease and to die following a breast cancer (BC) diagnosis compared to women from other racial/ethnic groups. While there are many contributing factors to this inequity (i.e., tumor biology, social and structural health determinants, racial injustice, and differential access to and utilization of high-quality mammography, diagnostics and therapies), persistent underrepresentation of Black patients in cancer clinical trials (CTs) slows scientific advancements. Objective: The goal of the FOR ME (Fostering Opportunities in Research through Messaging and Education) Study is to develop, optimize, and test a narrative decision aid intervention (web-based video) for Black women diagnosed with BC to promote shared decision making and CT participation. Here, we report on the development phase, wherein our objective was to identify salient themes and to understand lived experiences to enhance authenticity and to inform video content. Methods: Guided by community-based participatory research approaches, we used multiple qualitative methods (key informant interviews (KIIs) and story circles) to identify barriers and facilitators that support decision-making and CT participation. The KIIs, completed in-person, via phone, or video conferencing, were recorded and professionally transcribed. The research team used thematic analysis and inductive coding approaches. First, a subset of transcripts was annotated, then annotations were compiled into a preliminary codebook. Inter-coder reliability testing is ongoing to improve quality and to refine the codebook. The analysis team is using Dedoose, to analyze quotations and code co-occurrences, application frequencies, and relationships. Data collection and analysis of the story circles is ongoing. Results: In total, 30 Black women with BC participated in KIIs. Interviewees ranged in age from 27 to 75 years (M=59 + 12 years); concerning insurance, 63% had a public and 33% had a private source. About 27% were currently receiving BC treatment and 27% had prior CT participation. Participants expressed both positive and negative perceptions of CTs, sometimes concurrently. Barriers to CT participation included competing responsibilities, logistical burdens, ineffective provider communication, a lack of knowledge of CTs, individual and systemic racism, CT burdensome characteristics (invasive, potential for side effects), and comorbidities. Facilitators to CT participation included strong patient-provider communication and relationships, CT non-burdensome characteristics (non-invasive, minimal side effects), having a sense that participation benefits future generations, increased understanding of the CT, and feeling empowered in decision-making .Conclusion: To promote health equity in CTs, interventions should promote strong culturally sensitive patient-provider communication with emphasis on shared decision-making and patient empowerment along with emphasis on benefits toward future generations to promote a willingness to participate in CTs. Citation Format: Leslie R Carnahan, Vida Henderson, Tigist Mersha, Neha Hippalgaonkar, Ryan Nguyen, Eliza B Cohn, Kauthar Salum, Ana Williams, Lolita Coleman, Beulah Brent, AnneMarie Murphy, Paris Thomas, Paramjeet Khosla, Kent Hoskins. “If it’s something that I can do for my future generations…”: Using multiple qualitative methods to inform an intervention to promote shared decision making and participation in clinical trials among Black women diagnosed with breast cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A060.

Exploring the Experiences of Pediatric Patients with Sickle Cell Disease and Their Families

Background: Sickle Cell Disease (SCD) is a common lifelong genetic disorder of red blood cells, which causes abnormal hemoglobin shape often resulting in pain crises and other serious health complications (Ware, et al., 2017). SCD disproportionally affects people of African descent, and several recent surveys have shown that patients with SCD experience discrimination in healthcare settings (Nelson and Hackman, 2013; Haywood, et al., 2014; Kanter, 2020; Oyedeji and Strouse, 2020). In pediatrics, parents of patients with SCD report higher levels of race-related discrimination in healthcare settings compared to families with other chronic illnesses, as well as decreased satisfaction in several areas of their care (Brousseau, 2009; Oyedeji, 2020; Kanter, et al., 2020). This qualitative project aimed to explore further specific, actionable areas of dissatisfaction and any areas of increased satisfaction among pediatric patients with SCD and their families. Methods: Semi-structured interviews were conducted with pediatric patients with SCD and/or their guardians at one academic institution. Any patient with SCD over the age of eight was eligible to participate in an interview, and parents of a child with SCD of any age were eligible to participate, as well. Interviews were audio-recorded and took place in person in clinic. Recordings were then transcribed verbatim. The interviews were qualitatively coded using standard multi-level semantic analysis, working directly from the transcriptions and audio-recordings. Seven (41%) interviews were independently double-coded, and discrepancies were resolved by consensus. Final codes were analyzed, and major themes were identified. Results: Eighteen pediatric patients with SCD and/or their families were asked to participate in the study, and seventeen (94%) agreed. There were twenty-six total participants. Ten family interviews were conducted, and another seven were conducted with parents only because the patients were younger than eight years old. Fifteen families identified as African American, one family identified as Hispanic, and one family identified as African. Patients and their families described five main areas leading to dissatisfaction in the healthcare setting: (1) Long wait times; (2) Neglect for SCD protocols within emergency departments; (3) Biases against patients with sickle cell disease; (4) Frustration with procedures, specifically with blood draws; (5) Lack of empathy and compassionate listening among healthcare providers. Positive experiences were almost all due to aspects of strong patient-provider relationships. Outside of the healthcare setting, patients and their families emphasized the need for improved education and awareness of SCD within the community. Conclusion: While this qualitative study explored perspectives from only a limited number of pediatric families, these conversations provided insight into specific areas of dissatisfaction among patients with SCD. This research provides actionable items that healthcare providers can apply to help improve the healthcare experiences and the everyday lives of children with SCD. Additional efforts and resources should be directed toward addressing social determinants of health and systemic racism to future improve healthcare experiences of patients with SCD.

Investigating the role of interpersonal relationships on low-income SUD patients’ recovery: a qualitative analysis of various stakeholders in New York state

Background While positive impacts of recovery capital and social capital in facilitating substance use disorder (SUD) recovery is increasingly documented, research has shown that low-income and marginalized individuals have lower social capital and may rely on different networks. A more comprehensive approach is needed to understand the social capital of low-income individuals with SUD and how these relationships impact their treatment and recovery. Methods Qualitative data were gathered through semi-structured interviews and analyzed employing thematic analysis. Participants included individuals with SUD (n = 10), clinicians (n = 12), and policy leaders (n = 13). Results Three themes emerged: 1) Patients’ positive and negative interpersonal relationships with friends and family influenced decisions to seek treatment; 2) strong patient-provider relationships, often defined by the quality of SUD providers and treatment settings, were perceived as crucial for staying in treatment; and 3) justice involvement facilitated treatment access yet deteriorated treatment engagement. Themes emphasized social and structural factors that inhibit patients from fostering support and treatment engagement. Conclusions Our study underscores the importance of interpersonal relationships in SUD treatment-seeking and recovery and the need for positive interactions across the care continuum within broader social networks. Opportunities for positive interpersonal relationships include increasing access to language-concordant treatment; provider training to enhance cultural humility and patient-provider relationships; and mechanisms that improve interpersonal relationships between patients, parole officers, and other justice system members. Accentuating the role of interpersonal relationships and expanding social support interventions can pave the way for structural changes that improve recovery by harnessing different types of social capital.

The use and effects of telemedicine on complementary, alternative, and integrative medicine practices: a scoping review

BackgroundTelemedicine includes the delivery of health-care services and sharing of health information across distances. Past research has found that telemedicine can play a role in enhancing complementary, alternative, and integrative medicine (CAIM) while allowing the maintenance of cultural values and ancestral knowledge. This scoping review synthesized evidence regarding the use of telemedicine in the context of CAIM.MethodsFollowing Arksey and O’Malley’s scoping review framework, CINAHL, PsycINFO, MEDLINE, EMBASE and AMED databases were searched systematically. The CADTH website was also searched for grey literature. Eligible articles included a CAIM practice or therapy offered through telemedicine, with no restrictions placed on the type of telemedicine technology used. Inductive thematic analysis was conducted to synthesise common themes among the included studies.ResultsSixty-two articles were included in this synthesis. The following themes emerged: 1) the practitioner view of CAIM delivered through telemedicine, 2) the patient view of CAIM delivered through telemedicine, and 3) the technological impacts of telemedicine delivery of CAIM.ConclusionsStudies have shown that telemedicine delivery of CAIM is feasible, acceptable, and results in positive health outcomes. Some barriers remain such as the presence of chronic illness and morbidity, inability to form strong patient-provider relationships relative to face-to-face approaches, and technological difficulties. Future intervention research should focus on reducing such barriers, as well as explore which patient population would realize the greatest benefit from CAIM delivered via telemedicine, and the impact of interventions on providers and caregivers.

374 Shared decision making for eczema patients and caregivers is not dependent on length of relationship with a provider or provider specialty

Abstract Shared decision making (SDM) is used in clinical settings to help patients make decisions regarding their treatment in collaboration with their healthcare provider (HCP). Shared decision making is well-suited for eczema as many treatment and management options exist, and there is significant disease, lived experience and patient preference heterogeneity. While a strong patient–provider relationship is likely important to facilitate SDM, the assumption that a long-term relationship between a patient and an eczema specialist leads to better SDM has not been evaluated. This study aims to understand the impact of the duration of the patient–provider relationship and type of provider on SDM experience, confidence to engage and trust in the HCP. The National Eczema Association conducted an online 64-question survey January 12 to March 14, 2021 of adult patients and caregivers of children with atopic dermatitis (AD). The SDM experience, assessed with the SDMQ9 instrument (score ranges transformed to 0–100), self-reported confidence to engage in SDM (categories: not confident at all/slightly confident/moderately confident vs. very confident/extremely confident) and trust in provider were compared by time with primary eczema HCP (categories: ≤12 months, 13–36 months and >36 months) and whether or not the HCP was a specialist (Dermatologist or Allergist vs. other provider types). Additionally, four groups were created for comparison of SDM experience: (i) patients who considered themselves to be well informed about the causes of eczema currently working with eczema specialists, (ii) patients not adequately informed and working with specialists and patients (iii) informed or (iv)uninformed working with nonspecialists. ANOVA was used for group comparison of continuous variables and Kruskal–Wallis tests were used for proportions. Responses from 767 adults and 177 caregivers (944 total) met inclusion criteria. Patients were primarily female (80.2%) and had a mean eczema RECAP score of 11.4. There was no difference in SDMQ9 score by time with HCP [≤12 months (62.6; n = 281), 13–36 months (66.9; n = 261) and >36 months (65.1; n = 402)], although respondents who saw their HCP longer than 12 months indicated they were more confident to engage in SDM (P < 0.001) and were more likely to ‘always’ trust their HCP (P < 0.001). There was no difference in SDMQ9 score, confidence to engage or trust in HCP for those seeing specialists (n = 734) vs. nonspecialists (n = 210). However, patients who were well informed had higher SDMQ9 scores than those who were not adequately informed, regardless of whether or not they were seeing a specialist (20.1 points higher for those who were well informed/seeing a specialist and 17.6 points higher for well informed/nonspecialist). The same was true for confidence to engage in SDM. Trust and confidence can build over time between patients with AD and providers, which may have an impact on treatment decisions and adherence. However, not all patients with AD and caregivers have access, resources or the ability to have long-term relationships with providers who are eczema specialists. This study shows that neither of those are prerequisite for patients with AD to engage in productive SDM, but that patient knowledge may be highly important. This highlights the need for comprehensive patient education across eczema care settings.

VALUES AND PREFERENCES OF PATIENTS AND CAREGIVERS REGARDING TREATMENT OF ATOPIC DERMATITIS: A SYSTEMATIC REVIEW

<h3>Introduction</h3> Patient values and preferences can inform atopic dermatitis (AD) care. Systematic summaries of studies addressing patient and preferences have not been previously available. <h3>Methods</h3> Paired reviewers independently systematically screened MEDLINE, EMBASE, CENTRAL, PsychINFO, and CINAHL databases from inception until Feb 2022 for studies of patients with AD or their caregivers eliciting values and preferences about treatment, rated risk of bias, and extracted data. We used thematic and inductive content analysis to qualitatively synthesize the findings. GRADE-CERQual informed rating of quality of evidence. <h3>Results</h3> We identified 7780 studies of which 62 (n=19442; median age across studies 15 years [range 3-44]) proved eligible. High certainty evidence showed that patients and caregivers prefer to start with non-medical treatments and to step-up therapy with increasing AD severity. Moderate certainty evidence showed that side-effects from treatment are a significant concern. Low certainty evidence showed that patients and caregivers prefer odourless treatments that are not visible and have a low impact on daily life. Patients value treatments capable of relieving itching and burning skin and prefer to apply topical corticosteroids sparingly. Patients value a strong patient-provider relationship. <h3>Conclusion</h3> We systematically reviewed patient and caregiver values and preferences and identified 7 themes in relation to the management of AD: there is a preference to start with non-medical treatments, avoid negative side effects, relieve itching and burning, use steroids sparingly, use treatments with limited visibility or odour, use treatments with limited impact on daily activities, and a desire for a stronger patient-provider relationship.

Doctors Speak: A Qualitative Study of Physicians' Prescribing of Antidepressants in Functional Bowel Disorders.

Tricyclic antidepressants (TCAs) are frequently prescribed for chronic functional pain disorders. Although the mechanism of action targets pain perception, treating patients with TCAs for disorders conceptualized as "functional" can promote stigmatization in these patients because it hints at psychological dimensions of the disorder. The goal of this study was to understand how physicians prescribe TCAs in the face of this challenge. We interviewed eleven gastroenterologists in tertiary care clinics specializing in functional gastrointestinal disorders, such as irritable bowel syndrome. We found that the physicians interviewed (1) were aware of the stigma attached to taking antidepressants for a medical condition, (2) emphasized biological, as opposed to psychological, mechanisms of action, (3) while focusing on biological mechanisms, they nevertheless prescribed TCAs in a way that is highly attentive to the psychology of expectations, making specific efforts to adjust patients' expectations to be realistic and to reframe information that would be discouraging and (4) asked patients to persist in taking TCAs despite common and, at times, uncomfortable side effects. In this context of shared decision making, physicians described nuanced understanding and behaviours necessary for treating the complexity of functional disorders and emphasized the importance of a strong patient-provider relationship.

Risk of suicide death in psychiatric patients according to the level of continuity of care and area deprivation: A population-based nested case-control study

Continuity of care and area deprivation have been implicated as possible risk factors of suicide in psychiatric patients. This nested case-control study aimed to examine the association between continuity of care and area deprivation and suicide death in patients with psychiatric disorders. Data were collected from the Korean National Health Insurance Service National Sample Cohort, 2003–2013. The subjects were 974 patients with psychiatric disorders who completed suicides. Each case was compared to three control cases with propensity score matching by gender, age, and follow-up period with incidence density sampling, comprising the final control group of 2,922 living patients. Hazard ratios (HR) for suicide risk considering continuity of care and area deprivation were analysed using a multiple conditional logistic regression. The average follow-up periods between the case and control groups were not statistically different (case: 277.6 weeks, control: 271.4 weeks, p = .245). Both poor continuity of care and higher area deprivation proved to be associated with increased risk of suicide (poor continuity of care; adjusted HR [AHR]: 3.38, 95% confidence intervals [CI]: 2.58–4.43, highest area deprivation; AHR: 1.93, 95% CI: 1.53–2.44). Poor continuity of care combined with highest area deprivation showed a negative synergistic effect on a highly increased risk of suicide (AHR: 2.88, 95% CI: 1.45–5.74). Age was effect modified between suicide risk and poor continuity of care as well as suicide risk and higher area deprivation. A strong patient-provider relationship with good continuity of care may lead to a lower possibility of suicide in psychiatric patients. Moreover, improving community capacity for suicide prevention as well as appropriate postvention should be addressed.

Multidisciplinary Controlled Substance Advisory Group Provides Support to the Primary Care Provider

The iatrogenic opioid crisis in the United States has stressed primary care providers (PCPs) to right size opioid prescribing. In 2016 the Centers for Disease Control and Prevention published guidelines for opioid prescribing.1 These guidelines, particularly when misinterpreted and misapplied, resulted in unintended consequences that directly affected PCPs, who generally have minimal training in pain management.2 In addition, many providers experience considerable distress, maintaining a strong patient-provider relationship while also making unpopular medication changes.

Patient and provider perspectives on self-administered electronic substance use and mental health screening in HIV primary care

BackgroundSubstance use disorders, depression and anxiety disproportionately affect people with HIV (PWH) and lead to increased morbidity and mortality. Routine screening can help address these problems but is underutilized. This study sought to describe patient and provider perspectives on the acceptability and usefulness of systematic electronic, self-administered screening for tobacco, alcohol, other substance use, and mental health symptoms among patients in HIV primary care.MethodsScreening used validated instruments delivered pre-appointment by both secure messaging and clinic-based tablets, with results integrated into the electronic health record (EHR). Qualitative analysis of semi-structured interviews with 9 HIV primary care providers and 12 patients in the 3 largest HIV primary care clinics in the Kaiser Permanente Northern California health system who participated in a clinical trial evaluating computerized screening and behavioral interventions was conducted. Interviews were audio-recorded and transcribed. A thematic approach was utilized for coding and analysis of interview data using a combination of deductive and inductive methods.ResultsFour key themes were identified: (1) perceived clinical benefit of systematic, electronic screening and EHR integration for providers and patients; (2) usefulness of having multiple methods of questionnaire completion; (3) importance of the patient–provider relationship to facilitate completion and accurate reporting; and (4) barriers, include privacy and confidentiality concerns about reporting sensitive information, particularly about substance use, and potential burden from repeated screenings.ConclusionsFindings suggest that electronic, self-administered substance use and mental health screening is acceptable to patients and may have clinical utility to providers. While offering different methods of screening completion can capture a wider range of patients, a strong patient–provider relationship is a key factor in overcoming barriers and ensuring accurate patient responses. Further investigation into facilitators, barriers, and utility of electronic screening for PWH and other high-priority patient populations is indicated.Trial registration ClinicalTrials.gov, NCT03217058. Registered 13 July 2017, https://clinicaltrials.gov/ct2/show/NCT03217058

The Effect of Mobile Care Delivery on Clinically Meaningful Outcomes, Satisfaction, and Engagement Among Physical Therapy Patients: Observational Retrospective Study.

BackgroundMusculoskeletal care is now delivered via mobile apps as a health care benefit. Although preliminary evidence shows that the clinical outcomes of mobile musculoskeletal care are comparable with those of in-person care, no research has examined the features of app-based care that secure these outcomes.ObjectiveDrawing on the literature around in-person physical therapy, this study examines how patient-provider relationships and program engagement in app-based physical therapy affect clinically meaningful improvements in pain, function, and patient satisfaction. It then evaluates the effects of patient-provider relationships forged through in-app messages or video visits and timely, direct access to care on patients’ engagement in their recovery.MethodsWe conducted an observational, retrospective study of 814 pre- and postsurveyed participants enrolled in a mobile app physical therapy program where physical therapists prescribed workouts, education, and therapeutic activities after a video evaluation from February 2019 to December 2020. We estimated generalized linear models with logit functions to evaluate the effect of program engagement on clinical outcomes, minimal clinically important differences (MCIDs) in pain (ΔVisual Analogue Scale ≤−1.5) and function (ΔPatient Specific Functional Scale ≥1.3), and the effects of patient-provider relationships and clinical outcomes on patient satisfaction—participant reported likelihood to recommend the program (Net Promoter Scores of 9-10). We estimated Poisson generalized linear models to evaluate the effects of stronger patient-provider relationships and timely access to physical therapy within 24 hours on engagement including the number of weekly workouts and weeks in the program.ResultsThe odds that participants (N=814) had a pain MCID increased by 13% (odds ratio [OR] 1.13, 95% CI 1.04-1.23; P=.003) with each weekly workout and the odds of a function MCID by 4% (OR 1.04, 95% CI 1.00-1.08; P=.03) with each week in the program. Participants with MCIDs in function and large changes in pain (Δ Visual Analogue Scale ≤−3.5) were 1.85 (95% CI 1.17-2.93; P=.01) and 2.84 times (95% CI 1.68-4.78; P<.001) more satisfied, respectively. Those with video follow-up visits were 2 to 3 times (P=.01) more satisfied. Each physical therapist’s message increased weekly workouts by 11% (OR 1.11, 95% CI 1.07-1.16; P<.001). Video follow-up visits increased weekly workouts by at least 16% (OR 1.16, 95% CI 1.04-1.29; P=.01) and weeks in the program at least 8% (OR 1.08, 95% CI 1.01-1.14; P=.02). Access was associated with a 14% increase (OR 1.14, 95% CI 1.05-1.24; P=.003) in weekly workouts.ConclusionsSimilar to in-person care, program engagement positively affects clinical outcomes, and strong patient-provider relationships positively affect satisfaction. In app-based physical therapy, clinical outcomes positively affect patient satisfaction. Timely access to care and strong patient-provider relationships, particularly those forged through video visits, affect engagement.

Barriers and facilitators to the diagnosis and treatment of depression in primary care in Colombia: Perspectives of providers, healthcare administrators, patients and community representatives

IntroductionDepression represents a major disease burden in Colombia. To better understand opportunities to improve access to mental healthcare in Colombia, a research team at Javeriana University conducted formative qualitative research to explore stakeholders’ experiences with the integration of mental healthcare into the primary care system. MethodsThe research team conducted 16 focus groups and 4 in-depth interviews with patients, providers, health administrators and representatives of community organisations at five primary care clinics in Colombia, and used thematic analysis to study the data. ResultsThemes were organised into barriers and facilitators at the level of patients, providers, organisations and facilities. Barriers to the treatment of depression included stigma, lack of mental health literacy at the patient and provider level, weak links between care levels, and continued need for mental health prioritization at the national level. Facilitators to the management of depression in primary care included patient support systems, strong patient-provider relationships, the targeting of depression interventions and national depression guidelines. DiscussionThis study elucidates the barriers to depression care in Colombia, and highlights action items for further integrating depression care into the primary care setting.

Patient experiences and strategies for coping with SLE: A qualitative study.

This study explored challenges that patients with systemic lupus erythematosus (SLE) and childhood-onset SLE (cSLE) face to identify modifiable influences and coping strategies in patient experiences. Participants were recruited from two academic medical centers through a Lupus Registry of individuals ≥18 years old and ≥4 1997 ACR classification criteria for SLE and a centralized data repository of cSLE patients, and participated in three focus groups. Transcripts were coded thematically and adjudicated by two independent reviewers. Thirteen adults, 7 (54%) with cSLE, participated in focus groups. Themes were categorized into two domains: (1) challenges with SLE diagnosis and management; and (2) patient coping strategies and modifiable factors of the SLE experience. Participants identified five primary challenges: diagnostic odyssey, public versus private face of SLE, SLE-related stresses, medication adherence, and transitioning from pediatric to adult care. Coping strategies and modifiable factors included social support, open communication about SLE, and strong patient-provider relationships. Several participants highlighted positive lessons learned through their experiences with SLE, including empathy, resilience, and self-care skills. Patients with cSLE and SLE identified common challenges, modifying influences and coping strategies based on personal experiences. A strong patient-provider relationship and trust in the medical team emerged as key modifiable factors. Deriving optimism from experiences with SLE was unique to several patients diagnosed as children or young adults. Leveraging factors that improved the participants' experiences living with SLE may be used in future studies to address vulnerabilities in care.

Barreras y facilitadores para el diagnóstico y tratamiento de la depresión en atención primaria en Colombia: Perspectivas de los proveedores, administradores de atención médica, pacientes y representantes de la comunidad

IntroductionDepression represents a major disease burden in Colombia. To better understand opportunities to improve access to mental healthcare in Colombia, a research team at Javeriana University conducted formative qualitative research to explore stakeholders’ experiences with the integration of mental healthcare into the primary care system. MethodsThe research team conducted 16 focus groups and 4 in-depth interviews with patients, providers, health administrators and representatives of community organisations at 5 primary care clinics in Colombia, and used thematic analysis to study the data. ResultsThemes were organised into barriers and facilitators at the level of patients, providers, organisations and facilities. Barriers to the treatment of depression included stigma, lack of mental health literacy at the patient and provider level, weak links between care levels, and continued need for mental health prioritisation at the national level. Facilitators to the management of depression in primary care included patient support systems, strong patient-provider relationships, the targeting of depression interventions and national depression guidelines. DiscussionThis study elucidates the barriers to depression care in Colombia, and highlights action items for further integrating depression care into the primary care setting.