Patient preference and adherence最新文献

Background: Medical travel is a global phenomenon with significant economic value. However, its impact is felt primarily in the patients' home countries. Therefore, it is essential to engage in patient experience-based reflection to ensure that policy improvements remain patient-centered. This includes drawing on patients' experiences both domestically and abroad when interacting with healthcare services especially hospitals.

Objective: This study aims to explore the experiences and emotional bonds that form between Indonesian patients and foreign healthcare providers.

Methods: This study conducted in-depth interviews with 15 patients who had sought medical treatment abroad, at least once in the past two years. Participants were recruited using the snowball sampling technique through patient networks.

Results: Most informants had sought treatment outside Indonesia, predominantly in Malaysia and Singapore, at least once a year. Three informants had engaged in medical travel for more than five years. The study identified seven key themes: 1) Disappointing Experiences in Indonesian Hospitals; 2) Lengthy Procedures; 3) Lack of Expertise in the Home Country; 4) Medical Outcome Considerations; 5) Cost; 6) Equipment; and 7) Relationships. The decision to seek care abroad was highly personal and often stemmed from negative experiences in Indonesian hospitals. Informants found their relationships with doctors and hospitals abroad to be particularly pleasant.

Conclusion: This study highlights that a combination of negative experiences in Indonesian hospitals and the perception that the quality of care in foreign hospitals is superior leads to repeated medical travel. Emotional bonds are formed between patients and their preferred doctors or hospitals overseas. Indonesian hospitals must develop a patient-centered service approach to improve healthcare retention.

Purpose: To examine barriers to medication self-management among community-dwelling older adults with multiple chronic conditions (MCCs) and to provide evidence to guide medication safety and targeted nursing interventions.

Patients and methods: A descriptive qualitative approach was used. Between July and September 2024, we recruited 14 community-dwelling older adults with MCCs from the geriatric medicine center of a tertiary hospital in the Inner Mongolia Autonomous Region. Face-to-face, semi-structured interviews were conducted. Empowerment theory served as the conceptual framework; data were analyzed using content analysis.

Results: Barriers to home-based medication self-management among older adults with MCCs were grouped into three domains: resources, agency, and outcomes. Resource-related barriers included (1) lack of long-term medication plans and follow-up support; (2) Inadequate aging-friendly design of medication management tools; and (3) barriers to self-medication due to excessive family intervention. Agency-related barriers included (1) health decisions primarily based on religious beliefs; (2) symptom-driven medication behavior; and (3) low-burden oriented medication management tendencies. Outcome-related barriers included disconnect between home self-monitoring and clinical feedback.

Conclusion: Community-dwelling older adults with MCCs encounter multiple challenges that hinder effective home-based medication self-management, including limited structural support, reduced self-management capacity, and a lack of effective feedback systems. The findings indicate that medication management can be optimized through improved digital and assistive tools, enhanced interprofessional collaboration, and more effective, tailored health education. Future research should prioritize high-risk populations and develop individualized intervention strategies.

Background: Treatment inertia in chronic heart failure (CHF) commonly refers to the failure to initiate or intensify evidence-based therapy in a timely manner and refers to delays, avoidance, or inadequate engagement by patients in evidence-based therapy. While the clinician or healthcare system level have been extensively studied, patient-level inertia among elderly adults remain under-investigated due to limited health literacy patient-related factors, particularly in China where healthcare access, insurance policies, and literacy levels differ significantly. Understanding the behavioral and contextual determinants of this phenomenon is crucial for improving disease management among aging populations.

Purpose: Guided by the COM-B (capability-opportunity-motivation-behavior) framework, this qualitative study explored patient-level treatment inertia and its influencing factors among elderly Chinese patients with CHF, aiming to inform culturally tailored interventions.

Methods: A descriptive phenomenological design was adopted. Semi-structured interviews were conducted with 14 hospitalized CHF patients aged ≥60 years from May to July 2024 in a tertiary hospital in Shandong Province. Data were analyzed using Colaizzi's seven-step method, following COREQ criteria for qualitative research reporting.

Results: Three themes emerged: (1) deficient capability (insufficient symptom perception and low health literacy); (2) weakened motivation (multiple pressures, distrust in medical technology, limited engagement incentives); (3) constrained opportunity (insufficient family support and limited medical resources).

Conclusion: Patient-level treatment inertia among elderly CHF patients arises from the interaction of cognitive, motivational, and systemic constraints. Enhancing health literacy, improving psychosocial motivation, and establishing family and community-based support systems may mitigate inertia and improve patient outcomes.

Purpose: To explore the factors influencing decision-making and the rehabilitation experiences of older women who underwent total knee replacement (TKR).

Methods: A qualitative descriptive design with purposive sampling was employed. Women aged over 60 who had undergone TKR at a medical center in northern Taiwan were recruited during COVID-19 pandemic. Data were collected through two rounds of face-to-face interviews (3-5 days and 6-8 weeks post-surgery) and a follow-up telephone interview conducted 6 months after surgery. Thematic analysis was performed using a constant comparative approach.

Results: Twenty women participated. A central theme-reclaiming independent life through surgical transformation-emerged, encompassing two interrelated themes: (1) Decision-making factors were driven by pain, external concerns (becoming a burden on the family, body image change), dissatisfaction with conservative treatments, and the influence of significant others (physicians, families and friends, peers); (2) Surgical recovery involved striving to achieve the "rehabilitation golden phase" by enduring pain, establishing personal goals, and working toward functional recovery, while managing "challenges in home-based rehabilitation" through coping strategies and social support, and engaging in "post-surgical reflections" to assess pain relief and identify levels of functional recovery.

Conclusion: Older women perceived TKR to regain mobility, autonomy, and reduce dependence on family members. Their decisions reflected the interplay between physical suffering and cultural expectations. Despite rehabilitation challenges, participants demonstrated resilience and strong motivation for recovery. These findings emphasize the importance of gender-sensitive, patient-centered decision-support strategies and family-inclusive, culturally responsive rehabilitation care.

Objective: Patients with chronic obstructive pulmonary disease (COPD) often suffer from both physical limitations and psychological distress, affecting their overall well-being. This study aims to evaluate the impact of combined psychological nursing and respiratory training on anxiety, depression, pulmonary function, dyspnea, exercise tolerance, and quality of life in COPD patients.

Methods: Clinical data from 180 COPD patients admitted to a hospital between January 2021 and June 2024 were retrospectively collected and analyzed. Patients were divided into a control group (routine care, n=90) and an intervention group (psychological nursing combined with respiratory training, n=90) based on the care they received. The outcomes compared between the two groups included depression scores (SDS), anxiety scores (SAS), pulmonary function indicators (forced expiratory volume in one second [FEV1], forced vital capacity [FVC]), dyspnea grading (mMRC score), 6-minute walk test (6MWT), and quality of life scores (SGRQ scale).

Results: The SAS and SDS scores in the intervention group were significantly lower than those in the control group (P<0.05), indicating significant improvements in anxiety and depression. FEV1 and FVC levels were found to be significantly higher in the intervention group (P<0.05), reflecting improved pulmonary function. The mMRC score was significantly lower in the intervention group (P<0.05), indicating reduced dyspnea. The 6MWT distance was significantly longer in the intervention group (P<0.05), demonstrating enhanced exercise tolerance. The SGRQ score was significantly lower in the intervention group (P<0.05), suggesting a significant improvement in quality of life.

Conclusion: Psychological nursing combined with respiratory training significantly reduces anxiety and depression, improves lung function and exercise tolerance, relieves dyspnea, and enhances quality of life in patients with COPD. It is recommended as a key component of comprehensive COPD management.

Purpose: To understand the real experience of self-management in home-based rehabilitation for spinal cord injury patients, and to investigate population differences and characteristics in self-management experiences and create tailored patient personas.

Patients and methods: A descriptive qualitative study was designed, and purposive sampling was utilized to choose 17 spinal cord injury patients for semi-structured interviews, guided by the concept of precision nursing. Colaizzi's seven-step analytical approach was applied to review the data. The label system for the self-management experience of home-based rehabilitation for spinal cord injury patients was refined and summarized, and then the patient persona was constructed. Figures and tables were combined to visualize patient personas.

Results: The patient persona labels for spinal cord injury patients' self-management of home-based rehabilitation were distilled into six dimensions: basic characteristics, cognitive characteristics, behavioral characteristics, psychological characteristics, social support, and medical resource status. Three categories of patient personas were created: patients who are autonomy-driven, patients who are passively dependent, and patients who are suffering and conflicted.

Conclusion: Patients with spinal cord injuries have a variety of home-based self-management experiences. To improve disease prognosis and patients' capacity for self-management during home rehabilitation, healthcare professionals must thoroughly evaluate patients' attribute features and create tailored intervention programs.

Background: Point-of-Care Quality Improvement (POCQI) is a technique used to improve the quality of health services. Improving antenatal care (ANC) is essential for better health outcomes in pregnant women. This study aimed to evaluate the effectiveness of the POCQI in improving general practitioners (GPs) compliance with ANC service standards and its impact on pregnant women's satisfaction in Indonesian community health centers. Indonesia was selected because it still faces gaps in maternal healthcare quality and resources.

Methods: A quasi-experimental pre-post study was conducted over six months at six community health centers in Cianjur District, West Java, Indonesia. The intervention involved eight GPs and 172 pregnant women. GPs' compliance and pregnant women's satisfaction were measured using structured questionnaires administered before and after the intervention. Data were analyzed using Rasch modeling with stacking and racking techniques, and the Wilcoxon signed-rank test.

Results: Significant improvements were found in both GPs' compliance and pregnant women's satisfaction. Stacking analysis showed an increases in mean logit person values from 2.78 to 5.24 for GPs' compliance (p = 0.018) and from 2.94 to 7.76 for pregnant women's satisfaction (p < 0.001). Racking analysis showed a significant decrease in item difficulty, with logit values decreasing from 0.01 to - 2.42 for GPs' compliance (p < 0.001) and from 1.89 to -1.89 for pregnant women's satisfaction (p = 0.043).

Conclusion: The POCQI approach effectively improved GPs' compliance with ANC standards and increased pregnant women's satisfaction. As a practical quality improvement strategy, the POCQI should be scaled up and integrated into primary health care systems to enhance the quality of ANC services in Indonesia.

Objective: To develop a nomogram prediction model for dietary behavior adherence in hemodialysis (HD) patients, providing a simple and accurate tool for individualized risk prediction and supporting effective intervention strategies.

Methods: A total of 236 HD patients admitted from January 2022 to January 2024 were retrospectively included as the modeling group, and another 121 HD patients admitted from January 2024 to May 2025 served as the validation group. Patients in both groups were classified into compliance and non-compliance groups according to their dietary adherence. Lasso regression and multivariate logistic analysis were used to identify independent predictors and construct the nomogram. Internal and external validation were performed using ROC curves, the Hosmer-Lemeshow (H-L) test, calibration curves, and decision curve analysis (DCA).

Results: Among the 236 patients in the modeling group, 73 (30.93%) showed dietary non-compliance. Age, years on dialysis, educational level, dietary knowledge, social support, family support, and self-care ability significantly differed between the two groups (P<0.05). Seven variables selected by Lasso regression were entered into logistic analysis. Age, years on dialysis, and poor self-care ability were risk factors for non-adherence, whereas higher educational level, better dietary knowledge, stronger social support, and family support were protective factors (P<0.05). The internal validation yielded an AUC of 0.884 and an H-L χ² of 7.346 (P=0.713), while the external validation showed an AUC of 0.902 and an H-L χ² of 7.342 (P=0.726). DCA indicated high clinical utility within threshold probabilities of 0.10-0.83 (internal) and 0.15-0.84 (external).

Conclusion: Age, years on dialysis, educational level, dietary knowledge, social support, family support, and self-care ability are key factors influencing dietary adherence in HD patients. The nomogram based on these variables demonstrated good discrimination and clinical benefit, aiding early identification of high-risk patients and supporting individualized dietary management.

Background: The dyadic management of COPD and the dyadic health status are profoundly affected by the dyadic appraisals of disease symptoms between patients and their caregivers. However, existing research has not adequately explored the discrepancies in these dyadic appraisals or their underlying determinants.

Methods: A cross-sectional study was conducted between February and March 2025 using convenience sampling. A total of 142 pairs of clinically stable patients with COPD and their spousal caregivers were recruited from the Department of Pulmonary Diseases at a tertiary Grade A hospital of traditional Chinese medicine in Jiangsu Province. Data were collected using the Memorial Symptom Assessment Scale, Mutuality Scale, Social Support Rating Scale, Self-Concealment Scale, and a general information questionnaire. SPSS 26.0 was used for data analysis, and linear regression was employed to identify the factors influencing the differences in symptom appraisal.

Results: High consistency was observed in the appraisals of physical symptom subscale score, total MSAS score, and global distress index by patients with COPD and their caregivers. However, the patients' score was higher than their caregivers' score as it came to the appraisals of psychological symptoms (patients' score: median, 0.33 [IQR, 0.00-0.50]; caregivers' score: median, 0.17 [IQR, 0.00-0.44]; P<0.001). Regression analysis indicated that the factors impacting the differences in psychological symptom appraisal were the patients' gender, the degree of self-concealment, the caregivers' social support, and their mutuality.

Conclusion: To decrease differences in the appraisal of psychological symptoms between the two parties and to advance the practice and development of the COPD care model, healthcare professionals should focus on the way patients and caregivers share about psychological states and fortify the structure of the caregiver support system.

Introduction: Home enteral nutrition (HEN) is recommended for patients with nutritional requirements who can stay outside the hospital environment. HEN guidelines recommend assessing health-related quality of life (HRQoL) to evaluate the effect of the treatment. In this context, NutriQoL^® is a specific questionnaire developed to assess HRQoL in patients receiving HEN and validated in Spanish population.

Methods: This was a prospective observational study was conducted in two Spanish hospitals to record and describe the evolution of HRQoL, in patients receiving HEN in routine clinical practice using NutriQoL^®.

Results: Fifty-seven patients participated in the study, of whom 36 patients attended at least one visit during the 6-month follow-up period. Most of them were at risk or moderate malnutrition (61.1%) or showed severe malnutrition (27.8%) at baseline. The mean (SD) NutriQoL score obtained at baseline was 69.4 (12.6), which increased to 71.0 (14.6) and 71.8 (14.1) at 3 and 6 months of follow-up, respectively. Approximately 60% of patients had good HRQoL, while 25% had excellent HRQoL. At 6-months follow-up visit, 46.4% of patients had good HRQoL, and 32.1% excellent. Patients receiving oral HEN showed a higher score compared with those fed by a non-oral method/route. Proportion of patients at risk or with moderate malnutrition maintained at 6 months, and there were no patients with severe malnutrition, increasing the proportion of patients with normal nutrition to 38.5%. Additionally, physicians considered HRQoL evaluation useful for clinical practice. Limitations of the study include small sample size, and a loss follow-up after 6 months.

Conclusion: The assessment of HRQoL evolution using NutriQoL in patients receiving HEN appears valuable, as it provides valuable insights contributing to a more comprehensive nutritional evaluation and enhancing holistic patient care.