Patient preference and adherence最新文献

Background: Quality of postoperative recovery is an important perioperative patient-reported outcome. However, there are limitations in the development process and content of existing scales.

Purpose: To develop and validate a universal patient-reported outcome measure, the postoperative recovery scale for adult (PRSA), to assess early and long-term postoperative recovery.

Patients and methods: The PRSA was developed through a new conceptual framework, systematic literature review, patient interview, and Delphi consultation. Then, the PRSA and the 15-item quality of recovery scale (QoR-15) were employed to evaluate the measurement properties of PRSA in 180 adult patients undergoing abdominal surgery.

Results: A 10-item PRSA scale was developed through a systematic review of 1602 literature, interviews with 138 patients, and two rounds of Delphi consultation. The correlation coefficient between the PRSA and QoR-15 ranged from 0.780 to 0.904 (P < 0.001), and the PRSA indicated great validity in distinguishing patients with complications. The internal consistency and test-retest reliability of the PRSA were satisfactory. Besides, the time to complete the PRSA was 27.5s (95% CI: 24.5-30.0 s) shorter than QoR-15, and more patients thought that completing the PRSA was easy compared to QoR-15 (65.7% vs 57.2%, P < 0.001).

Conclusion: The PRSA scale is a universal patient-reported outcome measure that can be utilized for evaluating postoperative recovery. It shows great measurement properties in patients undergoing abdominal surgery.

Purpose: Appalachian Kentucky, a 32-county region in the eastern part of the state, has elevated colon cancer mortality rates. While recommended as the standard of care, access to adjuvant chemotherapy treatment is limited in this region due to scarce health services and significant social and geographical barriers. The purpose of this investigation was to improve understanding of barriers that cancer patients residing in rural areas not served directly by tertiary medical systems must overcome in completing adjuvant therapy.

Methods: Participants were recruited from two medical centers: A tertiary care NCI designated Cancer Center and a regional hospital. Participants underwent a 15-20 minute interview to assess factors associated with adherence to adjuvant treatment recommendations. Grounded theory identified themes related to patient behaviors and non-adherence to standard of care recommendations.

Results: Data were collected in 45 telephone and in-person patient interviews, 26 from an NCI-designated cancer center and 19 from a rural hospital. Statistically the two groups were equivalent in terms of age, subjective health status, and medical comorbidities. Six themes were identified from analysis of the transcribed interviews including: confidence in my care provider, communication, treatment issues, distrust, faith, and barriers to obtaining healthcare. Participants completing adjuvant therapy were more likely to express trust in their provider and describe fewer barriers to obtaining healthcare than those not completing adjuvant therapy.

Conclusion: Barriers to completing adjuvant therapy may differ between rural and urban healthcare systems which may yield opportunities for targeted interventions to improve rates of completion of colon cancer adjuvant chemotherapy.

Purpose: With the growing use of digital health technologies (DHT) in clinical trials, the opportunity to use technology to promote greater patient centricity and inclusivity has emerged. Current technology provides various mechanisms for communication, eg, through voice or text, however, participant familiarity and preference for them is poorly understood. The purpose of this study was to understand participants' communication preferences, their comfort with and use of messaging methods and their attitudes towards different communication and technology-driven symptom reporting methods in clinical trials.

Participants and methods: Fifty-five participants, with any form of chronic health condition or recent intervention causing daily pain or discomfort were recruited by way of convenience sample for a single-centre, non-interventional, single-visit study, conducted in Ireland. Participants completed a questionnaire on communications preferences via an app on the participants' own electronic device.

Results: In communication with friends and family, 69.6% of participants most preferred to use a messaging service. In communication with their healthcare provider, 72.7% preferred phone calls. Respondents preferred to communicate with friends/family via text messages (80.4%) over other methods. In clinical trial settings, participants are willing to use messaging methods to communicate with their physician. When reporting symptoms, most preferred a phone/video call to physicians (50.9%) and touch screen on device/smartphone (47.3%). 72.7% preferred to report symptoms using their own phone. Some respondents were interested in having the device read the questions/answers aloud (36.4%) and answer questions verbally (41.8%).

Conclusion: Participants were familiar with various communication methods but showed different preferences to communicate with friends and family versus healthcare professionals. For reporting symptoms in a clinical trial while at home, split results suggested a preference for independent reporting as well as live communication with physician, perhaps reflecting the rising use of telehealth. Further exploration is needed for the use of questions read aloud or answered verbally when reporting symptoms in a clinical trial.

Purpose: To identify the suitability of pharmacy-based measures for determining medication adherence in routine clinical use.

Methods: Data were obtained through PubMed and Scopus databases up to December 2023 without publication year restrictions. This review included English studies on assessing medication adherence for hypertension, hyperlipidemia, asthma, chronic obstructive pulmonary disease, and diabetes, using pharmacy databases and providing full-text access. We investigated evidence quality utilizing the Newcastle-Ottawa Scale for non-randomized studies (cohort, case-control, and cross-sectional) and the Risk of Bias Assessment Tool for Non-randomized Studies-2 and JADAD scales for quasi-experiments and randomized control trials, respectively. We determined validity characteristics (completeness, accuracy, reliability, objectivity, continuous adherence history, non-intrusiveness, sensitivity, and specificity) and applicability (cost-effectiveness, ease of use, and interpretability) to evaluate the suitability of pharmacy-based medication adherence measures in clinical settings.

Results: This review retrieved 1513 studies, of which 74 met the inclusion criteria. All of the studies, which were published from 2000 to 2023 and mostly utilized a retrospective cohort design (n = 53), included 17.6 million patients. Of the 74 studies, 50 were conducted in the United States. Diabetes mellitus (n = 40) was the most prevalent disease, whereas the medication possession ratio (n = 46) and prescription days covered (n = 31) were the most prevalent pharmacy-based matrix. According to the results, 73 articles demonstrated validity characteristics, whereas 1 article lacked these characteristics. All 74 (100%) articles had applicability characteristics.

Conclusion: This systematic review demonstrates that pharmacy-based measures possess valid characteristics, including comprehensive, accurate, objective, reliable, and continuously updated adherence history records. These measures are designed to minimize disruption while offering high sensitivity and specificity. Furthermore, they are characterized by their practicality, being cost-effective, easy to implement, and easy to interpret. These findings suggest that pharmacy-based measures are potentially suitable to assess medication adherence for routine clinical use.

Background: Treatment guidelines recommend metformin as initial drug in many people with type 2 diabetes (T2D) and low risk of cardiovascular disease, with the possibility to switch to or add other drug classes. A decision aid (DA) could be useful to incorporate a patient's preferences in the decision of which drug class to choose. We developed such a DA and assessed the perspectives of people with T2D towards its comprehensibility and usability.

Methods: The DA consists of a paper-based leaflet followed by a web-based preference elicitation exercise. The leaflet aims at informing patients about drug characteristics (eg, efficacy, safety). The relative importance of these drug characteristics for each participant are then assessed in a web-based exercise, which results in a ranking of the preferred drug classes. A qualitative study using semi-structured interviews was conducted among Dutch patients with T2D who were or had ever been under pharmacological treatment for T2D. The audio-recorded interviews were transcribed verbatim. Thematic analysis was conducted.

Results: Fifteen patients participated (median age 64 years, nine women, and most had T2D >10 years). Risk of hypoglycaemia was most often the characteristic to which patients attached the highest importance (n=5). A glucagon-like peptide-1-antagonist weekly injection fitted best the preferences of most patients (n=8). The interviews revealed improvements for text, pictograms and figures, and formatting, and increased comprehension of how patients completed the DA. Regarding usability, missing information was identified, as well as patients' perspectives about the usefulness of the DA and its role in shared-decision making.

Conclusion: The DA was considered promising for shared-decision making but further improvements regarding its comprehensibility and usability are needed, for which this study provides clear guidance.

Background: Patient satisfaction is an important predictor of quality of care and hospital services. Patient satisfaction survey provides not only valuable insight into patient experience of care but also evidence that guides quality improvement in both system and organization levels. The paper aims to prove the value of system-wide satisfaction survey of patients and demonstrate whether data collected from a national patient satisfaction survey in three-year period can predict trends in patient experience of care.

Methods: Patient satisfaction data of 148 hospitals were extracted from the annual National Public Hospital Patient Satisfaction Survey (NPHPSS) for Shandong Province between 2019 and 2021. Pearson test or Spearman test was performed to clarify the differences in satisfaction and relationship between variables. A linear regression model was established to describe the impact of variables on satisfaction.

Results: From 2019 to 2021, there was a significant enhancement in overall patient satisfaction, particularly in communication areas, for both outpatients and inpatients (p = 0.000). A strong and positive correlation between outpatient and inpatient satisfaction was observed over three years (p = 0.000). However, outpatients reported lower satisfaction than inpatients regarding the hospital environment and communication (p < 0.05). Patient care experiences also varied across different hospital categories. In addition, the maturity of the Health Information Management System (HIMS) positively influenced inpatient satisfaction (p < 0.05).

Conclusion: A nationwide patient satisfaction survey can predict benefits of quality improvement initiatives and identify changing trends in the quality of hospital care. The strong correlation between outpatient and inpatient satisfaction underscores the importance of consistent medical service quality across the hospitals. HIMS upgrades are a worthwhile investment in enhancing patient experiences in public hospitals. Tailoring service improvement strategies to specific hospital contexts, such as type, location, and patient demographics, is crucial.

Purpose: This study aimed to evaluate the acceptance of moderate sedation (MS) as a behavior guidance technique (BGT) method among Saudi parents, and also assess their acceptance of other BGTs, including parental separation, papoose board (PB), and nitrous oxide (N₂O), used in conjunction with MS.

Patients and methods: This cross-sectional study was conducted at the Dental University Hospital, King Saud University, Riyadh, Saudi Arabia. It involved Saudi parents of children aged 3-5 years undergoing dental treatment with MS, alongside additional BGTs such as parental separation, PB, and N₂O. Parents completed a questionnaire with demographic details and a post-treatment acceptance survey evaluating their satisfaction with the MS. Descriptive statistics were used for demographic information and parental acceptance. Chi-square and Fisher's exact tests analyzed the association between parental acceptance and background characteristics.

Results: A total of 85 parents were included in the study. Among these parents, 77 (90.59%) accepted MS, reporting minimal distress during dental treatment, and 78 (91.76%) would choose MS again. The PB received strong support from 79 (92.94%) of parents, with 83 (97.65%) finding it useful for child protection. However, 43 (50.59%) of parents felt uncomfortable with parental separation during therapy.

Conclusion: Over 90% of Saudi parents showed high acceptance of MS and PB as BGTs. The study also revealed that 50.59% of parents were uncomfortable with being separated from their children during treatment. These findings highlight the need for strategies that can accommodate family involvement in pediatric dentistry, ultimately improving parental satisfaction.

Introduction: Pharmacists are essential healthcare professionals which play a pivotal role in public health protection by offering diverse pharmacy services. This includes not only serving individuals in Ukraine but also addressing the needs of Ukrainian citizens residing in Poland. An exemplary initiative is the creation of the website farmaceucidlaukrainy.pl, which provides organized and systematic support.

Aim: This study aims to evaluate the perceptions of Ukrainian immigrant patients from Ukraine regarding the advanced pharmaceutical consultation service provided by Polish pharmacists.

Material and methods: This study included 250 respondents from Ukraine. The study was conducted in 2022 using an anonymous survey. The survey was distributed after pharmaceutical consultations in one of the cities near the Polish-Ukrainian border. As part of the project, Ukrainian patients who had run out of medicines due to war brought their medications to pharmacy counselling points organized by Polish pharmacists, and the pharmacists helped them find equivalents ias well as help treated minor ailments in Poland.

Results: Practically all respondents strongly agree with all the statements posed in the survey, the percentage of such responses was close to 95%, with the lowest percentage observed for the statement "If possible, I would like this kind of service to be offered in any Polish pharmacy", which was 90.40%.

Conclusion: Ukrainian patients highly appreciated the pharmaceutical consultation services provided by Polish pharmacists. The information given by pharmacists was clear and practical, and the services were deemed highly supportive. Expanding such initiatives to other assistance points could enhance the support network for displaced individuals.

Background: Effective self-management in the early stage of chronic kidney disease (CKD) is key to delaying disease progression. However, no studies have confirmed that the combined support of internal individual factors and external family environmental factors may play an important role in the self-management of patients with early CKD.

Purpose: This current study aims to explore the effect of family function on the self-management of patients with early CKD and examine the mediating roles of self-perceived burden and ego depletion.

Patients and methods: Three hundred and sixty patients with stage 1-3 CKD participated in the cross-sectional survey and completed structured questionnaires, including the family APGAR index, self-perceived burden scale, self-regulatory fatigue scale and chronic kidney disease self-management instrument. Mplus 8.3 was used to establish a structural equation model.

Results: Family function had a positive predictive effect on self-management (β = 0.231, P < 0.001). Self-perceived burden and ego depletion were not only single mediating variables between family function and self-management but also played a chain-mediating role. The total indirect effect was 0.304 (95% CI: 0.234 to 0.388, P < 0.001), accounting for 56.82% of the total effect (β = 0.535, 95% CI: 0.420 to 0.651, P < 0.001).

Conclusion: This study highlights the importance of self-management for patients and their families and provides new important theoretical guidance for multiple interventions of improving family function, reducing self-perceived burden and ego depletion to improve self-management, which is of great value in delaying the progression of renal disease.

Background: Chronic disease has become an increasing burden in Indonesia, increasing the importance of treatment adherence to control the disease prognosis. Therefore, we aim to determine the prevalence and characteristics of nonadherence in Indonesian chronic disease population.

Methods: We identified 11,408 adult subjects with chronic diseases from the fifth Indonesian Family Life Survey. We defined treatment nonadherence as the outcome variable and characteristics related to the World Health Organization Multidimensional Adherence Model as exposure variables. We used descriptive and multivariable analyses to analyze factors related to treatment nonadherence.

Results: We identified that 57% (95% CI 56.1-57.9) of chronic disease patients were nonadherent to their treatment. Treatment nonadherence was notable in subjects with liver disease (61.8%), tuberculosis (59.8%), digestive diseases (57.9%), other lung diseases (56.8%), psychiatric diseases (51.6%), asthma (51.2%), and hypertension (50%). Treatment nonadherence was associated with socioeconomic-related factors of being aged 15-65 years, living in rural areas, having history of formal education, and having a household size of 2-6 people. Furthermore, in patient- and condition-related factors, positive perceptions of their health condition, missing 0-7 days of their regular activity in the last month, being ex- and non-smokers, having no depression symptoms, and having only one chronic disease were associated with treatment nonadherence.

Conclusion: Treatment nonadherence for chronic diseases in Indonesia was found to be prevalent. Further consideration of characteristics associated with treatment nonadherence should be given to ensure optimal control of chronic diseases.