Treatment Journeys Research Articles

From search to support: the role of UGC in stigmatized consumers’ mental health treatment journeys

Purpose This study aims to investigate the mental health treatment journeys of stigmatized consumers using user-generated content (UGC) while also examining the role of UGC in the journey. Design/methodology/approach This study offers valuable insights from 68 distinct, stigmatized consumers through a qualitative content analysis of 73 YouTube product review videos related to ten antidepressants. Data is coded, combining inductive coding with theory to provide a nuanced interpretation. Applying the Common-Sense Model of Self-Regulation to traditional consumer journey concepts, the analysis of UGC is structured by a unique mental health treatment journey. Findings The findings show that consumers use UGC to destigmatize their mental health treatment by engaging in dynamic reflection throughout their journey, rather than following traditional feedback models. Unlike typical consumption patterns, where search is limited to the initial stage, these consumers search at every journey phase while sharing insights that offer valuable support to others which, sometimes they report, is reciprocated by viewers. Research limitations/implications Theoretically, this study introduces an innovative framework blending psychological and marketing theories to address a gap in health-care service marketing literature concerning long-term mental health treatment journeys. By introducing the concept of dynamic reflection, it demonstrates how consumers actively engage in and share insights throughout their treatment process, differing from traditional feedback models, and highlights the impact of UGC on health-care service provision. Practical implications Findings could inform potential health-care provider interventions that may improve treatment effectiveness. Originality/value Although stigmatized consumers’ experiences have been examined, their treatment experiences have not been framed within a journey framework.

Chronic pelvic pain treatment understanding what matters: a social media survey.

Chronic pelvic pain (CPP) is a debilitating condition that reduces quality of life (QoL). In the United Kingdom, there is currently no standardised treatment pathway for women suffering from CPP. Therefore, it is essential to understand individuals' concerns regarding CPP, their treatment experiences and what they seek from treatment. To do this, we conducted a two-month social media survey focused on the UK population to explore treatment experiences and identify the factors that people consider important to managing their condition. Of 1,279 respondents, women who completed ≥50% of the questions were included (n = 864; 68%). Results suggest that many women are living with moderate-intensity CPP and experience symptoms for 6 years (average) before receiving a diagnosis. Initially, most women see general practitioners and gynaecologists (90%), with varied care beyond these providers. Using an adapted STarT Back tool, 85% of respondents were classified as medium-high risk of poor outcomes based on physical, psychosocial, and psychological risk. Thematic analysis identified that people desire treatment validation/understanding, self-management, and support to manage pain and QoL. Notably, only 26% of respondents report satisfaction with their healthcare experience, suggesting that current treatment approaches do not address these themes. In conclusion, results suggest that treatment should focus on quality-of-life improvement to enhance CPP treatment outcomes and satisfaction. Findings endorse the need for improved and standardised treatment approaches that address patients' needs. CPP is persistent pain in the lower abdomen or pelvis for at least 6 months. It is common and affects approximately 1 in 6 women in the UK. To improve treatment, it is important to understand people's treatment experiences and treatment needs. We conducted a social media survey to understand how people with CPP experience treatment and what they would like from treatment. The survey was posted online for two months (May and June 2023) and received 897 responses. Responses suggested that people experience long waits before receiving help for their pain and that treatment journeys vary greatly. Overall, people reported low treatment satisfaction. People felt that effective treatment should improve pain and QoL. Themes of understanding their pain, knowing how to manage their pain and understanding treatments were identified as important. Clinicians should consider QoL and pain education as part of treatment.

Impact of next-generation sequencing vs polymerase chain reaction testing on payer costs and clinical outcomes throughout the treatment journeys of patients with metastatic non-small cell lung cancer.

For patients with metastatic non-small cell lung cancer (mNSCLC), next-generation sequencing (NGS) biomarker testing has been associated with a faster time to appropriate targeted therapy and more comprehensive testing relative to polymerase chain reaction (PCR) testing. However, the impact on payer costs and clinical outcomes during patients' treatment journeys has not been fully characterized. To assess the costs and clinical outcomes of NGS vs PCR biomarker testing among patients with newly diagnosed de novo mNSCLC from a US payers' perspective. A Markov model assessed costs and clinical outcomes of NGS vs PCR testing from the start of testing up to 3 years after. Patients entered the model after receiving biomarker test results and then initiated first-line (1L) targeted or nontargeted therapy (immunotherapy and/or chemotherapy) depending on actionable mutation detection. A few patients with an actionable mutation were not detected by PCR and inappropriately initiated 1L nontargeted therapy. At each 1-month cycle, patients could remain on treatment with 1L, progress to second line or later (2L+), or die. Literature-based inputs included the rates of progression-free survival (PFS) and overall survival (OS), targeted and nontargeted therapy costs, total costs of testing, and medical costs of 1L, 2L+, and death. Per patient average PFS and OS as well as cumulative costs were reported for NGS and PCR testing. In a modeled population of 100 patients (75% commercial and 25% Medicare), 45.9% of NGS and 40.0% of PCR patients tested positive for an actionable mutation. Relative to PCR, NGS was associated with $7,386 in savings per patient (NGS = $326,154; PCR = $333,540) at 1 year, driven by lower costs of testing, including estimated costs of delayed care and nontargeted therapy initiation before receiving test results (NGS = $8,866; PCR = $16,373). Treatment costs were similar (NGS = $305,644; PCR = $305,283). In the PCR cohort, the per patient costs of inappropriate 1L nontargeted therapy owing to undetected mutations were $6,455, $6,566, and $6,569 over the first 1, 2, and 3 years, respectively. Relative to PCR testing, NGS was associated with $4,060 in savings at 2 years and $1,092 at 3 years. Patients who initiated 1L targeted therapy had an additional 5.4, 8.8, and 10.4 months of PFS and an additional 1.4, 3.6, and 5.3 months of OS over the first 1, 2, and 3 years, respectively, relative to those who inappropriately initiated 1L nontargeted therapy. In this Markov model, as early as year 1, and over 3 years following biomarker testing, patients with newly diagnosed de novo mNSCLC undergoing NGS testing are projected to have cost savings and longer PFS and OS relative to those tested with PCR.

Patient experiences in outpatient substance use disorder treatment: A qualitative study exploring both clinical and non-clinical contexts

BackgroundAddressing the persistent treatment gap in substance use disorder (SUD) remains a critical challenge, with only 13 % of Americans with SUDs receiving necessary treatment. We explored the complexities of engaging in SUD treatment from patients' perspectives and aims to provide a comprehensive understanding of their treatment experiences. MethodsWe conducted semi-structured interviews with 34 patients who had been attending outpatient SUD clinics in New York State for 6 or less months. Participants were recruited from seven clinics using purposive sampling. Interviews were conducted between June and August 2022. We conducted thematic analysis of coded data to explore patients' experiences and preferences while navigating their treatment journeys. ResultsCritical elements for a positive treatment experience included cultural humility, confidentiality, consistency, trust, peer counselors with SUD experience, a strong sense of connection, and addressing needs beyond clinical settings. These included assistance with housing and employment, participation in external clinic events, and access to amenities like coffee and snacks. Participants favored holistic treatment approaches integrating mental health and involving peer recovery counselors. However, participants also identified ineffective aspects, including rigid and generic approaches, stigmatizing attitudes, and challenges related to communities and environmental influences. ConclusionThe study highlights the multifaceted nature of outpatient SUD treatment, emphasizing the integration of patient-centered, holistic, and culturally competent approaches. Tailoring interventions to individual circumstances and acknowledging the diverse needs of patients are imperative for effective healthcare practices.

The role and value of counsellors in the treatment journeys of people with tuberculosis and their families: Qualitative insights from the South Fly District of Papua New Guinea.

Combined education and counselling can contribute to person-centred care for tuberculosis (TB), improving uptake, adherence, and outcomes of treatment for TB disease and TB infection. Though strongly recommended by the World Health Organization for all people diagnosed with TB, education and counselling is not widely implemented in TB programs around the world. In 2016, a pilot TB education and counselling program, delivered by trained professionals and peers, was initiated to support people on TB treatment in the South Fly District of Papua New Guinea. This article reports on select findings from a qualitative study that examined the socio-cultural dimensions of TB, including treatment support such as education and counselling, in the South Fly District. An assessment on data collected during 128 semi-structured in-depth interviews of the role of counsellors on TB treatment journeys revealed strong participant support for the counsellors and the services they delivered, with particular emphasis on the emotional support provided to address fears and concerns related to TB diagnosis and treatment, and to support treatment adherence; valuable attributes of counsellors; their role as intermediaries between patients and health workers; their provision of biomedical knowledge of TB transmission and disease; and their assistance in addressing stigma and discrimination from family and community. Participants also noted how tackling the socio-structural issues that drive TB transmission in people's homes and communities were beyond the remit of counsellors' work. TB education and counselling should be an essential part of all TB services to provide support and encouragement for people to continue treatment to completion.

SAHELI: Study and Action on Hysterectomy: Evidence on women’s health through the life course in India. Protocol for a mixed-methods study

Hysterectomy, removal of the uterus, is a commonly performed surgery for gynaecological morbidities. Emerging evidence indicates that hysterectomy performed before age 45 (early hysterectomy), is associated with considerable risks to women’s health. While most evidence on hysterectomy is from high-income settings, national surveys from India report high prevalence of early hysterectomy in specific regions, as well as higher prevalence amongst women in rural areas and with less education. The median age at hysterectomy in India is close to ten years before the onset of natural menopause. India has recently introduced national guidelines to address early hysterectomy, but large evidence gaps on the causes and consequences remain – which in turn limits the potential effectiveness of interventions at the clinical, health system and community level. Methods SAHELI is a Team Science study that will examine: (i) individual, social and health system determinants of early hysterectomy; (ii) women’s treatment pathways to hysterectomy and for gynaecological morbidity in general; and (iii) the consequences of undergoing hysterectomy on women’s physical, mental, economic and social well-being across the life course. This mixed-methods study includes population surveys amongst women in ages 25–49 in three high-prevalence states; qualitative health systems research to trace treatment journeys with women, health care providers and other stakeholders; evidence syntheses; and knowledge translation activities to ensure findings inform co-produced strategies and interventions. The study is grounded in a feminist epidemiology approach, aiming to examine individual and structural causes of vulnerability and prioritising the views of women, particularly in knowledge translation. Conclusions SAHELI, implemented by an all-women, multi-disciplinary team, is the first study in India to examine the causes and consequences of hysterectomy in a life course approach. We aim to influence interventions, policy and future research on women’s health, particularly access to quality gynaecological care and comprehensive health services through the life course.

Adherence and persistence to tafamidis treatment among Medicare beneficiaries in the presence of a patient assistance program

Tafamidis is the only disease-modifying therapy approved to treat patients in the United States with transthyretin amyloid cardiomyopathy (ATTR-CM), which most commonly affects patients aged ≥ 65 years. The manufacturer operates a patient assistance program (PAP) to support access to tafamidis. This study conducted Privacy Preserving Record Linking (PPRL) using Datavant tokens to match patients across Medicare prescription drug plan (PDP) and PAP databases to evaluate the impact of PAPs on treatment exposure classification, adherence, and persistence determined using Medicare PDP data alone. We found 35% of Medicare PDP patients received tafamidis through the PAP only; 14% through both Medicare PDP and the PAP, and 51% through Medicare PDP only. Adherence and persistence were comparable between these cohorts but underestimated among patients who received ≥ 2 prescriptions through Medicare PDP and ≥ 1 through the PAP when solely using Medicare data versus pooled Medicare and PAP data (modified Medication Possession Ratio: 84% [69% ≥ 80% adherent] vs. 96% [93%]; Proportion of Days Covered: 77% [66% ≥ 80% adherent] vs. 88% [88%]; mean days to discontinuation: 186 vs. 252; total discontinuation: 13% vs. 11%). Cross-database PPRL is a valuable method to build more complete treatment journeys and reduce the risk of exposure misclassification in real-world analyses.

Prevalence of Sleep Deprivation and Cognitive Impairment in Cancer Patients Undergoing Chemotherapy

Abstract Background: Sleep deprivation and cognitive impairment represent significant issues among cancer patients undergoing chemotherapy, significantly impacting their daily activities and treatment journeys. The side effects of chemotherapy frequently contribute to disturbances in sleep and cognitive functions in these individuals. Recognizing the scope of these difficulties is essential for developing tailored interventions that cater to the specific requirements of cancer patients, ultimately improving their quality of life and treatment results. Materials and Methods: The research took place at a tertiary cancer care hospital, where 83 eligible chemotherapy patients were enlisted and assessed for sleep quality using the PSQI questionnaire and cognition using MoCA. Each questionnaire was administered only once. A PSQI total score of ≤5 indicated good sleep quality, while a score exceeding 5 indicated poor sleep quality. Similarly, a MoCA score below 26 suggested impaired cognition. Results: Among the entire sample, sleep deprivation was observed in 80.7% of chemotherapy patients, while cognitive impairment was identified in 44.6% of chemotherapy patients. Conclusion: The study deduces that sleep deprivation and cognitive impairment are exceedingly prevalent among cancer patients undergoing chemotherapy.

PRO-WAVE1: Monitoring patient reported outcomes (PROs) in prostate cancer through Wave Health, a novel ePRO health platform.

e23190 Background: It is well established that the monitoring and evaluation of PROs in cancer patients has a positive impact in both quality of life and overall survival [Basch E., JAMA 2017]. In parallel, the widespread use of electronic devices such as smart phones in the general population have increased significantly over recent years [Statista, 2023], representing a unique opportunity to operationalize ePROs. However, there is uncertainty about the feasibility and applicability of these technologies in certain patient population such as prostate cancer (PC) patients. PRO-WAVE1 aims to determine the acceptability and engagement of the Wave Health patient app and healthcare provider portal, enhanced for PC patients. Specific endpoints include measuring longitudinal use of varying ePROs to impact care management, patient health literacy, and ability to identify and manage emerging risks. Methods: Patients across eight sites in Spain engaged with the Wave Health App over a 13-week period. Each week, patients completed a validated weekly symptom review (WSR) assessing 16 Prostate cancer-specific symptoms, including severity and/or frequency of each; as well as a health-related QoL (FACT-P) and health literacy survey (CHLT-30-Dkspa). A report summary of the patients’ WSR was generated for care team view in the Wave Health Connect platform – specifically to conduct weekly check ins on patients, including verifying patient completion; evaluating report content; indicating plans for follow up per patient; and rating their perceived value of the platform. Results: 98 patients were enrolled in the study – of which 82 actively participated in the study (84% acceptance). The compliance rate for the ePRO questionnaires was 93.3%, while during their participation, patients used the app for an average of 12.2 weeks, and approximately two-thirds (67.4%) used the app for all 13 weeks. Patient satisfaction with the platform was 93%, with 100% of respondents feeling the information provided in the app was relevant to their personal experience. Correspondingly, almost all HCPs (98%) rated the platform as useful – with the majority willing to recommend it to their peers and future patients; 90% of HCPs positively perceived the platform’s impact on the quality of communication with patients. Conclusions: Study results exceeded expectations for patient acceptability and engagement with the app; as well as perceived usefulness of the portal among HCPs – suggesting the platform as an impactful tool for patients working with HCPs to manage treatment journeys. A larger study using a comparator arm will help further evaluate the impact on costs and clinical outcomes.

AN ANALYSIS OF THE IMPACT OF PEER SUPPORT GROUPWORK ON THE PSYCHOLOGICAL WELLBEING OF THE LIMB RECONSTRUCTION PAEDIATRIC PATIENTS ATTENDING THE NATIONAL ORTHOPAEDIC HOSPITAL CAPPAGH, DUBLIN

AN ANALYSIS OF THE IMPACT OF PEER SUPPORT GROUPWORK ON THE PSYCHOLOGICAL WELLBEING OF THE LIMB RECONSTRUCTION PAEDIATRIC PATIENTS ATTENDING THE NATIONAL ORTHOPAEDIC HOSPITAL CAPPAGH, DUBLIN

Pegvaliase for the treatment of phenylketonuria: Final results of a long-term phase 3 clinical trial program

Phenylketonuria (PKU) is a genetic disorder caused by deficiency of the enzyme phenylalanine hydroxylase (PAH), which results in phenylalanine (Phe) accumulation in the blood and brain, and requires lifelong treatment to keep blood Phe in a safe range. Pegvaliase is an enzyme-substitution therapy approved for individuals with PKU and uncontrolled blood Phe concentrations (>600 μmol/L) despite prior management. Aggregated results from the PRISM clinical trials demonstrated substantial and sustained reductions in blood Phe with a manageable safety profile, but also noted individual variation in time to and dose needed for a first response. This analysis reports longer-term aggregate findings and characterizes individual participant responses to pegvaliase using final data from the randomized trials PRISM-1 (NCT01819727) and PRISM-2 (NCT01889862), and the open-label extension study 165–304 (NCT03694353). In 261 adult participants with a mean of 36.6 months of pegvaliase treatment, 71.3%, 65.1%, and 59.4% achieved clinically significant blood Phe levels of ≤600, ≤360, and ≤ 120 μmol/L, respectively. Some participants achieved blood Phe reductions with <20 mg/day pegvaliase, although most required higher doses. Based on Kaplan-Meier analysis, median (minimum, maximum) time to first achievement of a blood Phe threshold of ≤600, ≤360, or ≤ 120 μmol/L was 4.4 (0.0, 54.0), 8.0 (0.0, 57.0), and 11.6 (0.0, 66.0) months, respectively. Once achieved, blood Phe levels remained below clinical threshold in most participants. Sustained Phe response (SPR), a new method described within for measuring durability of blood Phe response, was achieved by 85.5%, 84.7%, and 78.1% of blood Phe responders at blood Phe thresholds of ≤600, ≤360, or ≤ 120 μmol/L, respectively. Longer-term safety data were consistent with previous reports, with the most common adverse events (AEs) being arthralgia, injection site reactions, headache, and injection site erythema. The incidence of most AEs, including hypersensitivity AEs, was higher during the early treatment phase (≤6 months) than later during treatment. In conclusion, using data from three key pegvaliase clinical trials, participants treated with pegvaliase were able to reach clinically significant blood Phe reductions to clinical thresholds of ≤600, ≤360, or ≤ 120 μmol/L during early treatment, with safety profiles improving from early to sustained treatment. This study also supports the use of participant-level data and new ways of looking at durable blood Phe responses to better characterize patients' individual PKU treatment journeys.

Identifying patient profiles and mapping treatment journeys of ARPI-treated, taxane-naive patients with metastatic prostate cancer across three countries in a digital patient survey.

56 Background: A fully digital survey of patients with prostate cancer (PCa) was conducted in Germany (DE), the US and the UK to map characteristics, experiences and attitudes. Real-world profiles and treatment journeys, as well as intercountry differences, of taxane-naive patients with metastatic PCa (mPCa) are relatively unknown; data from the survey were leveraged to gain insights into these. Methods: From February 9 to April 10, 2021, DontBePatient Intelligence conducted a survey of patients with PCa. We identified responses from patients with mPCa who were taxane-naive and received at least one androgen receptor pathway inhibitor (ARPI), such as abiraterone or enzalutamide. Demographics, disease characteristics, diagnostic trends and treatments journeys were analyzed, using descriptive and inductive statistics. Results: In total, 458 taxane-naive patients (mean age 68.9 years) had received one ARPI, while 36 had received two. There were differences in time since, mode of, and disease stage at diagnosis between countries (Table). Notably, more US patients were diagnosed through routine screening, yet more had been diagnosed with metastases vs UK/DE. UK patients more frequently reported hospital urologists and oncologists being involved in diagnosis vs DE/US patients. In DE, practice urologists were more frequently reported as being involved vs other specialties throughout the patient journey and these were more involved than in the UK/US. UK patients were more satisfied with radio/brachytherapy and hormone therapy and less satisfied with surgery vs DE/US patients. We uncovered considerable differences in treatment journeys between countries. UK patients had received less surgery vs DE/US patients (9.8% vs 41.5/33.1% patients), driven by less use in 1L. Radio/brachytherapy use was highest in the US (69.4%) and lowest in DE (37.3%), driven by infrequent 1L use in DE. Treatment with bone strengthening agents was less common in the UK (16.4%) vs DE/US (37.3/33.8%). Conclusions: In different countries, taxane-naive patients who received one ARPI have different characteristics at diagnosis and distinct patterns of care. It is important to understand how these differences may affect diagnostic and therapeutic trends to maximally improve patient care in this treatment setting. [Table: see text]

‘ARVs are a constant reminder of lost freedom, whereas for others, they are liberating’: understanding the treatment narrative among people living with HIV (PLHIV) in Malawi and Zimbabwe–a qualitative study

ObjectiveThe aim of the research was to understand what drives and motivates young women living with HIV in their treatment journeys, as well as their key influencers. The findings will...

Using Natural Language Processing and Patient Journey Clustering for Temporal Phenotyping of Antimicrobial Therapies for Cat Bite Abscesses

BackgroundTemporal phenotyping of patient journeys, which capture the common sequence patterns of interventions in the treatment of a specific condition, is useful to support understanding of antimicrobial usage in veterinary patients. Identifying and describing these phenotypes can inform antimicrobial stewardship programs designed to fight antimicrobial resistance, a major health crisis affecting both humans and animals, in which veterinarians have an important role to play. ObjectiveThis research proposes a framework for extracting temporal phenotypes of patient journeys from clinical practice data through the application of natural language processing (NLP) and unsupervised machine learning (ML) techniques, using cat bite abscesses as a model condition. By constructing temporal phenotypes from key events, the relationship between antimicrobial administration and surgical interventions can be described, and similar treatment patterns can be grouped together to describe outcomes associated with specific antimicrobial selection. MethodsCases identified as having a cat bite abscess as a diagnosis were extracted from VetCompass Australia, a database of veterinary clinical records. A classifier was trained and used to label the most clinically relevant event features in each record as chosen by a group of veterinarians. The labeled records were processed into coded character strings, where each letter represents a summary of specific types of treatments performed at a given visit. The sequences of letters representing the cases were clustered based on weighted Levenshtein edit distances with KMeans++ to identify the main variations of the patient treatment journeys, including the antimicrobials used and their duration of administration. ResultsA total of 13,744 records that met the selection criteria was extracted and grouped into 8,436 cases. There were 9 clinically distinct event sequence patterns (temporal phenotypes) of patient journeys identified, representing the main sequences in which surgery and antimicrobial interventions are performed. Patients receiving amoxicillin and surgery had the shortest duration of antimicrobial administration (median of 3.4 days) and patients receiving cefovecin with no surgical intervention had the longest antimicrobial treatment duration (median of 27 days). ConclusionOur study demonstrates methods to extract and provide an overview of temporal phenotypes of patient journeys, which can be applied to text-based clinical records for multiple species or clinical conditions. We demonstrate the effectiveness of this approach to derive real-world evidence of treatment impacts using cat bite abscesses as a model condition to describe patterns of antimicrobial therapy prescriptions and their outcomes.

PRO-WAVE1: Monitoring patient reported outcomes (PROs) in prostate cancer through Wave Health, a novel ePRO health platform.

114 Background: It is well established that the monitoring and evaluation of PROs in cancer patients has a positive impact in both quality of life and overall survival.1 In parallel, the widespread use of electronic devices such as smart phones in the general population have increased significantly over recent years,2 representing a unique opportunity to operationalize ePROs. However, there is uncertainty about the feasibility and applicability of these technologies in certain patient population such as prostate cancer (PC) patients. PRO-WAVE1 aims to determine the acceptability and engagement of the Wave Health patient app and healthcare provider portal, enhanced for PC patients. Specific endpoints include measuring longitudinal use of varying ePROs to impact care management, patient health literacy, and ability to identify and manage emerging risks. Methods: The study is underway across eight sites in Spain. Patient ePRO engagement is being evaluated through the administration of 19 ePRO questionnaires over the course of 13 weeks, including: health-related QoL (FACT-P); health literacy (CHLT-30-Dkspa); and weekly reviews of symptoms (WSR). Compliance rates per patient and per cohort will be reported at assessment time-points and for the entire study period. Secondary objectives evaluated include engagement with Wave Health App; changes in HRQoL; changes in health literacy; and the perceived value of the platform by patients and HCPs. Results: 98 patients were enrolled in the study. Patient cohort representation included: 44.9% mHSPC, 36.7% mCRPC, and 18.3% nmPC. Of the 98 patients, 84 successfully became active in the study and participated (85.7% acceptance). As of September 20, 2023, among the completed patients (N=46), the compliance rate for the ePRO questionnaires was 93.7%. During their participation, these patients used the app for an average of 12.2 weeks, and approximately two-thirds (67.4%) used the app for all 13 weeks. Weekly “usefulness” ratings among the HCPS averaged 3.6 (scale: 1 “not at all useful” to 5 “very useful”). Conclusions: Study results exceeded expectations for patient acceptability and engagement with the app; as well as perceived usefulness of the portal among HCPs – suggesting the platform as an impactful tool for patients working with HCPs to manage treatment journeys. A larger study using a comparator arm will help further evaluate the impact on costs and clinical outcomes. 1. Basch E., JAMA 2017. 2. Statista, 2023.

Editorial

Physical therapy is undergoing a revolutionary transformation due to the integration of artificial intelligence (AI) in its dynamic landscape. This editorial highlights the significant influence of AI on geriatric rehabilitation, highlighting its potential to improve patient outcomes and redefine the role of therapists. [1]. The AI approach to rehabilitation is distinct in that it creates personalised programmes based on specific patient data. This customising tackles each patient as a unique organism with unique circumstances, optimising outcomes and ushering in a new age in geriatric rehabilitation by ensuring no two treatment journeys are the same. [2]. The introduction of AI-enabled smart gadgets enhances the rehabilitation experience. As digital companions, these devices deliver real-time feedback during exercises, changing dull routines into fascinating and stimulating activities. There are numerous examples, ranging from wearable sensors that measure movement to interactive platforms that promote a collaborative rehabilitation process between patients and therapists. [3]. The importance of artificial intelligence in remote patient monitoring is a game changer in geriatric rehabilitation. Therapists may now monitor progress and make changes to treatment plans in real time, overcoming geographical limitations. This skill is especially important in elderly care, when mobility issues may make regular clinic visits difficult. Even from a distance, AI ensures that rehabilitation remains a constant and dynamic process [4]. AI integration not only improves care quality but also addresses accessibility difficulties. Patients can participate in rehabilitation exercises from the comfort of their own homes, removing obstacles to critical healthcare services. This transition is critical, especially for older patients who may suffer transportation or mobility issues [5]. AI is a valuable ally for therapists, relieving administrative duties and freeing up time for personalized service. AI improves the process by automating paperwork, data analysis, and treatment planning, allowing therapists to focus on what matters most—the unique needs of each geriatric patient [6]. AI's abilities extend to creating significant insights from massive information, allowing for a more in-depth understanding of rehabilitation effectiveness and patterns. These insights enable therapists to make evidence-based decisions, ensuring that interventions are not just personalized but also founded on a plethora of data-driven knowledge. [6]. Patients are becoming proactive participants in their rehabilitation journey in the age of AI. AI provides individuals with information on their development, allowing people to make informed decisions and feel in control of their health. This shift in dynamics not only improves therapy adherence but also has significant psychological consequences for senior patients, contributing to total rehabilitation success [7]. While the potential of AI in geriatric rehabilitation is immense, we must acknowledge the challenges it presents. Data privacy and ethical considerations demand careful attention. As custodians of patient well-being, it is incumbent upon the healthcare community to ensure the responsible and transparent use of AI technologies, respecting the sanctity of patient information [8]. As we look at the current scenario, it is clear that AI is having a significant impact on geriatric rehabilitation, and the journey has barely begun. In the future, ongoing AI integration promises more advancements, unlocking new dimensions in personalised treatment and extending the bounds of what is achievable in geriatric rehabilitation. Finally, the convergence of AI with geriatric rehabilitation provides a ray of hope, providing a road towards improved patient care and therapist efficiency. Let us tread with the responsibility and forethought required to harness the full potential of AI in altering the landscape of physical therapy for our ageing population as we navigate this disruptive era.

Treatment journey of patients with hepatocellular carcinoma using real-world data in British Columbia, Canada.

This study examined treatment patterns, survival outcomes and healthcare costs related to hepatocellular carcinoma (HCC) in British Columbia. The study utilized data from two physician databases (HCC and MOTION) and the provincial British Columbia transplant database. The analysis revealed diverse treatment approaches and identified the varying treatment journeys of patients. Liver transplant and systemic therapies demonstrated improved survival rates. However, there was a scarcity of Canadian-specific cost data. The research emphasizes the complexities of managing HCC and underscores the need for personalized treatment strategies to enhance patient outcomes. These findings contribute valuable insights into HCC management and provide a foundation for future studies and interventions aimed at optimizing care and resource allocation.

PeopleWith supporting nurses to better understand patient treatment journeys

PeopleWith supporting nurses to better understand patient treatment journeys

Investigating social deprivation and comorbid mental health diagnosis as predictors of treatment access among patients with an opioid use disorder using substance use services: a prospective cohort study

BackgroundOpioid use is a major public health concern across the globe. Opioid use and subsequent access to care is often shaped by co-occurring issues faced by people using opioids, such as deprivation, mental ill-health, and other forms of substance use. We investigated the role of social deprivation and comorbid mental health diagnoses in predicting re-engagement with substance use services or contact with crisis and inpatient services for individuals with opioid use disorder in secondary mental health care in inner-city London.MethodsWe conducted a prospective cohort study which followed individuals diagnosed with a first episode of opioid use disorder who accessed substance use services between September 2015 and May 2020 for up to 12 months, using anonymised electronic health records. We employed negative binominal regression and Cox proportional survival analyses to assess associations between exposures and outcomes.ResultsComorbid mental health diagnoses were associated with higher contact rates with crisis/inpatient services among people with opioid use disorder: incidence rate ratios (IRR) and 95% confidence intervals (CI) were 3.91 (1.74–9.14) for non-opioid substance use comorbidity, 8.92 (1.81–64.4) for a single comorbid mental health diagnosis, and 15.9 (5.89–47.5) for multiple comorbid mental health diagnoses. Social deprivation was not associated with contact rates with crisis/inpatient services within this sample. Similar patterns were found with time to first crisis/inpatient contact. Social deprivation and comorbid mental health diagnoses were not associated with re-engagement with substance use services.ConclusionComorbid substance and mental health difficulties amongst people with an opioid use disorder led to earlier and more frequent contact with crisis/inpatient mental health services during the first 12 months of follow up. Given the common co-occurrence of mental health and substance use disorders among those who use opioids, a better understanding of their wider needs (such as social, financial and other non-medical concerns) will ensure they are supported in their treatment journeys.

Moving forward on the road to recovery after concussion: participant experiences of interdisciplinary intervention for persisting post-concussion symptoms

Purpose Many factors contribute to persisting post-concussion symptoms (PPCSs), necessitating multi-modal treatment. Quantitative investigations have shown the potential of interdisciplinary intervention to reduce the burden of PPCSs and facilitate return to activities. There are often varied responses to intervention, warranting further investigation of potential factors underlying treatment response. This study aimed to explore participant experiences of i-RECOveR, an interdisciplinary intervention for PPCSs and its impact on symptoms, daily function, and concussion beliefs. Materials and Method Semi-structured interviews were conducted 1-month post-treatment via videoconferencing with 13 individuals (61% female) with mild traumatic brain injury (M age =39.77 years, SD = 16.27) who participated in i-RECOveR. Interview transcripts were analysed thematically. Results Three themes reflected participants’ treatment journeys from concussion to life after treatment: (1) Dissatisfaction with Previous Consultations, reflected personal experiences prior to commencing treatment; (2) Perceived Active Ingredients of Intervention, reflected participant experiences of i-RECOveR; and (3) Impact of Interdisciplinary Intervention, reflected a range of positive changes after completing i-RECOveR. Conclusions Findings highlight current gaps in the acute management of concussion and provide end-user insights into the facilitators and barriers of treatment engagement and response. Responses also highlight the potential positive impact of interdisciplinary treatments. Clinician perspectives should be explored in future research.