International Journal for Quality in Health Care最新文献

Background: Diabetes mellitus, particularly type 2 diabetes (T2DM), is a chronic disease associated with serious complications, such as heart disease, kidney failure, and blindness. Continuous glucose monitoring (CGM) systems have emerged as a more effective alternative to traditional fingerstick testing, offering patients greater control over their condition. Despite their potential benefits, several barriers to CGM sensor use persist, limiting their widespread adoption among patients with T2DM. This review explores the barriers to CGM sensor use, particularly from the patient's perspective.

Methods: A systematic literature review is conducted following PRISMA guidelines. The search focuses on studies published between January 2018 and June 2024 and is performed in two primary databases, PubMed and Scopus, selected for their relevance to T2DM research. Studies are included if they explore challenges and barriers to CGM adoption, report patient perspectives, or provide insights into the usability and accessibility of technology. The data are analyzed using deductive content analysis, applying Wilson et al.'s thematic categories as a predefined framework to systematically classify and interpret barriers to CGM adoption. This approach ensures methodological consistency and alignment with existing research on eHealth adoption challenges.

Results: The review identifies several key barriers to CGM sensor use despite the benefits, such as improved glucose control and reduced hypoglycemic events. Major challenges include the high cost of sensors, wearability issues, discomfort from adhesive materials, and concerns about the visibility of the sensors. Additionally, patients report difficulties in interpreting the large volumes of data generated by CGM systems, as well as discomfort or fear related to sensor insertion. Lack of technological support, low health literacy, and insufficient social support are also identified as factors contributing to non-adoption.

Conclusions: Policymakers and healthcare providers are encouraged to address these barriers by developing patient-centered strategies that support the adoption of CGM sensors. Successfully overcoming these challenges can further support integrating CGM sensors with the Chronic Care Model and Automated Insulin Delivery systems. As an implication, this integration has the potential to enhance glycemic control and improve patient quality of life in the management of T2DM. Furthermore, addressing these barriers may drive advancements in sensor design, improve accessibility, and minimize the environmental impact of CGM sensor use.

Background: Patient experience is increasingly being recognized as a core component of quality healthcare. It captures various dimensions of a patient's interaction with healthcare providers that may influence patient satisfaction and ultimately impact the incidence of complaints or disputes. However, only limited research has investigated the financial implications of patient experience, particularly its association with medical dispute costs. This study sought to understand whether patient experience scores correlate with medical dispute costs and to provide insights into cost-effective strategies in patient-centred care.

Methods: We used a dataset that included patient experience scores and medical dispute costs over a defined period. Descriptive analysis, frequency distribution of disputes, and odds ratios were calculated to examine the initial patterns. Logistic regression models were applied using both logged and ratio-based dispute-cost transformations to assess the relationship between patient experience and dispute costs. The models were stratified according to patient experience type.

Results: The analysis revealed that higher patient experience scores were generally associated with reduced medical dispute costs, with significant relationships observed in specific models. In a cost-ratio model, doctor interactions showed a strong correlation with reduced dispute costs. For nurses, significant associations were observed in a logged cost model, suggesting that both nurses and doctors contributed uniquely to dispute costs.

Conclusion: This study demonstrated that improving specific domains of patient experience, such as patient rights, may serve as a cost-effective strategy for reducing medical dispute costs. These findings emphasize the importance of fostering patient-centred care and addressing institutional and contextual factors. These insights provide a foundation for targeted strategies to enhance patient satisfaction while promoting financial and operational stability in healthcare institutions.

Background: Persons with disabilities often encounter barriers in accessing healthcare services. However, research on the impact of disability on the continuity of care (COC) remains limited. We assessed the changes in COC among disabled individuals to monitor alterations in their healthcare accessibility.

Methods: This study used the National Health Insurance Service-National Sample Cohort 2.0 DB. The Bice-Boxerman COC Index (COCI; 0-1 range; higher values indicate greater COC) was used, with disability status of the participants determined from the registered data. Propensity-score matching was conducted for the control group. Difference-in-difference analysis was conducted to evaluate pre- and post-disability changes in COC for people with disabilities relative to those without.

Results: COCI values were analyzed for 9702 participants with disabilities and 19 404 control individuals. On average, the disability group scored 0.0343 lower than the control group 1 year before disability registration (P = .001) relative to the disability registration year. Similar results were obtained for the physical disability, visual disability, and hearing disability subgroups, with scores of -0.0342, -0.0394, and -0.0285, respectively (P < .0001 for all groups). On the other hand, the neurological disability subgroup showed a marginal change in the COCI score, peaking 2 years before disability registration (-0.0757, P < .0001).

Conclusion: Individuals with physical, visual, and hearing disabilities showed low COCI scores, with a significant decline occurring 1 year before disability registration. In contrast, the control group showed no change in COC. This result highlights the need to improve healthcare continuity, particularly for individuals with the respective disabilities.

Background: This study aimed to evaluate the quality of care in newly diagnosed rheumatoid arthritis (RA) patients by analyzing conventional disease-modifying antirheumatic drugs (cDMARDs) treatment patterns and healthcare utilization using a nationwide claims database.

Methods: This retrospective cohort study was conducted using the Korean Health Insurance Review and Assessment database. Study subjects were those who were newly diagnosed with RA (ICD-10 code M05, M06) and were prescribed a cDMARD in 2014, with follow-up until 2018. Demographic and clinical information, the level of healthcare (LOH) facilities at which the first prescription claim was made, and subsequent healthcare service utilization were collected. We also analyzed the initial pattern in cDMARD prescription and its retention rate.

Results: A total of 21 136 patients were analyzed. Diagnosis of seronegative RA (n = 14 571, 68.9%) was more common than seropositive RA. Seropositive RA was most often discovered in tertiary general hospitals (n = 2230, 34.0%), whereas seronegative RA was most diagnosed in primary care clinics (n = 7539, 51.7%) (P  <  .001). The most prescribed initial cDMARD was hydroxychloroquine as monotherapy (n = 9867, 46.7%). However, methotrexate, a well-established first-line cDMARD, was prescribed in 5447 (25.8%) patients. The discontinuation rate of cDMARD was higher in seronegative than seropositive patients (65.3% vs. 90.3%) and in patients first diagnosed in community LOH (P for trend < .001). The mean number of visits to any outpatient clinics (35/year) was substantially higher than that of the general population. Yet, the number of outpatient visits for RA management was only 2.8/year.

Conclusion: The quality of care for newly diagnosed RA patients in South Korea can be improved. Further education on accurate diagnosis and effective treatment is necessary to improve the quality of care provided by other specialists and general practitioners.

Background: The COVID-19 pandemic had a profound impact on healthcare systems globally, with the potential to aggravate levels of healthcare-associated harm. Due to radical changes within service provision, this period was considered likely to influence patient-reported safety concerns. We aimed to characterise the nature of these safety concerns at different time periods after the first UK lockdown.

Methods: A patient-reported safety concerns module was included within the UK COVID-19 Public Experience (COPE) study surveys at three time points: March/April 2021, September/November 2021, and March/April 2022. Participants were asked whether they had experienced any safety concerns whilst using healthcare services during the previous six months, the nature of the concern(s), and to provide a free-text response to describe it. Free-text data were reviewed to identify reports that met the National Health Service (NHS) definition of a patient safety incident. Descriptive analysis was undertaken to identify incident type, contributory factors, and patient outcomes, followed by thematic analysis of the most frequently reported incidents.

Results: Data from 11,604 completed questionnaires were screened over the three time points, and 1,363 (10.0%) participants reported a safety concern, and 722 (53%) concerns met the definition of a patient safety incident: 262/499 (53%) at 12 months; 215/456 (47.1%) at 18 months; and 245/408 (60.1%) at 24 months. The most frequently reported safety incidents involved access to healthcare professionals (12 months/18 months), and errors managing healthcare appointments (24 months). Prominence of themes fluctuated over time, as the context and policies that influenced the safety reports shifted. For example, geographical limitations on healthcare were evident at 12 months, mitigation from healthcare-associated harm by family members at 18 months, and concerns surrounding healthcare professional and other patient's behaviour at 24 months.

Conclusion: Healthcare organisations are undoubtedly still undergoing a protracted period of recovery. However, to protect health services from any further threats to functioning, organisations must review patient safety data systems and examine staff perspectives on the issues identified, notably in relation to infection control policies, social distancing, and patient access to health services. Learning from patient-reported experiences and considering how safety incidents are defined would support improvements in patient safety.

Background: Reports from patient experience and satisfaction surveys are currently being used to target health quality improvement. The patient's healthcare experience is indicative of the interpersonal quality of care and significantly correlates with patient satisfaction as an evaluative measure. Guided by Self-Determination Theory (SDT), this study aims to explore the association of predictor constructs in the theoretical model of STD-perceived provider communication (PPC) and other innate psychological constructs of competence and autonomy with self-rated health (SRH) and healthcare satisfaction (HS). Of particular interest is the SDT construct of relatedness. For this study, it was operationalized as the perceived health communication of a provider. Items relevant to SDT in the Health and Retirement Study (HRS) survey were tested, first, for whether they fall into the predicted SDT constructs and, second, whether and how these constructs were associated with self-reported health and patient HS.

Methods: Two-stage data were analyzed using subsamples from the 2018 and 2019 HRS. Independent variables included items measuring SDT constructs about PPC, psychological well-being, and self-efficacy. Outcome variables included SRH and dimensions of HS, such as cost, quality, and providers. In the first stage, descriptive analyses and exploratory factor analysis were performed to identify the underlying factor structure. Principal axis factoring was used to extract factors. In the second stage, these factors were used in structural equation modeling to examine the relationship between SRH and HS.

Results: Three factors with high internal consistencies (a > 0.8) and item-total correlations (r > 0.5) were identified. Data from the sample fit the structural model (χ2 = 0.00, CFI = 0.954, TLI = 0.946, RMSEA = 0.058, SRMR = 0.047). The structural phase indicated that PPC and competence were positively associated with SRH and HS. However, autonomy was only significantly associated with SRH but not with HS.

Discussion/conclusion: Individuals who rated PPC behaviors and their sense of competence more highly also showed higher satisfaction with multiple healthcare domains and their SRH status. Patient-centered determinants of health outcomes are complex, and more studies are needed to understand their nuances.

Background: Hypertension is a significant risk factor for cardiovascular diseases, and it contributed to 685 875 deaths in 2022 in the United States. While antihypertensive medications are effective, cost-related medication non-adherence (CRN) can hinder treatment. This study examined CRN among adults with hypertension, comparing older (≥65 years) and younger (18-64 years) individuals.

Methods: This analytical cross-sectional study utilized data from the National Health Interview Survey Sample from 2019 to 2022. Inclusion criteria involved responding yes to the question 'Have you ever been told by a doctor or health professional that you have hypertension?' and 'Are you currently taking medications for hypertension?'. Participants who lacked responses to any relevant questions were excluded (n = 4441). Participants were stratified into two age groups: 18-64 years old and ≥65 years old. CRN was determined based on measures such as skipping doses, taking less medication, delaying prescription refills, and forgoing medication due to the cost for any medication. Covariates included age, race, ethnicity, sex, insurance status, financial hardship, comorbidities, and geographical region. Unadjusted and adjusted logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CI).

Results: Of 48 559 hypertensive adults, there was a higher percentage of men in the 18-64 years age group compared with the group aged over 65 (51% vs 46%, P-value < .001). In addition, most women (54.0%) were over 65, compared with 48.6% in women between age 18 and 64 years (P-value < .001). Women aged 18-64 years more likely (adjusted odds ratio (aOR) 1.44; 95% CI 1.18, 1.75) to experience CRN than men. Notably, uninsured individuals in both the 18-64 (aOR 2.21; 95% CI 1.51, 3.25) and ≥ 65 (aOR 5.55; 95% CI 1.36, 22.75) age groups were at increased risk of facing CRN.

Conclusion: To mitigate CRN, health quality strategies like prescribing generics, connecting patients with assistance programs, and implementing policies to reduce out-of-pocket costs are essential.

Background: Implementing patient's own medication (POM) and self-administration of medication (SAM) has several benefits for safe and sustainable medication use, including enhanced patient empowerment reduced workload for hospital staff and decreased medication waste. Despite positive attitude of stakeholders, the upscaling of these strategies in hospitals remained limited. This study aimed to (i) identify barriers and facilitators for implementing POM and SAM and (ii) develop implementation strategies to address these.

Methods: Semistructured interviews were conducted among healthcare providers involved in the implementation of POM and SAM in 10 Dutch hospitals. The study population encompassed (hospital and outpatient) pharmacists, pharmacy technicians, nurses, and (ward) physicians. The topic guide was based on COM-B model. Barriers and facilitators were identified with thematic content analysis and were categorized to the Consolidated Framework for Implementation Research (CFIR). Implementation strategies were selected based on identified barriers through the CFIR- Expert Recommendations for Implementing Change (ERIC) tool and identified strategies were clustered into predefined focus areas to develop implementation targets.

Results: The 23 participants generally expressed a positive attitude towards implementation of POM and SAM. Themes reflecting facilitators related to (i) multiple benefits for patients, hospital, and society, (ii) a dedicated multidisciplinary implementation team, (iii) an iterative implementation process, whereas barriers related to (iv) substantial and invasive workflow changes, (v) reluctance to change responsibilities of healthcare providers, and (vi) unclear regulations and reimbursement. The CFIR-ERIC tool highlighted 57 implementation strategies in nine key focus areas to support the implementation of POM and SAM.

Conclusion: To implement POM and PAM successfully, strategies relating to involving stakeholders, changing infrastructure, and using an iterative implementation process are required.