158. Medical Care of Unaccompanied Asylum-Seeking Adolescents At The Geneva University Hospitals, Switzerland : A Qualitative Study To Explore The Challenges of Their Transition To Majority

Objective: To identify the key elements of environmental responsibility in hospital care and the stakeholders involved.Background: Hospital care causes a significant global environmental burden, which threatens human health and wellbeing. Environmental responsibility has been identified as an essential part of patient care with regard to health promotion and wellbeing of humans, but it has often been regarded as a secondary issue in hospitals. In addition, the lack of organizational structures and administrative as well as managerial support inhibit the promotion of environmental responsibility in hospitals.Methods: We used a qualitative study with semi-structured interviews and document analysis. Our data was drawn from the environmental managers of five Finnish university hospitals and documents on their environmental programs.Results: We found that the aim of environmental responsibility in hospital care was to avoid unnecessary emissions, and that it was guided by the authorities and by ethical values. It included targets for sustainable use of material, electricity, water and transport. Environmental responsibility required the involvement of several stakeholders, including administrators, environmental manager, immediate leaders, environmental support people, staff and patients. Implementation of environmental responsibility was promoted by collaboration, education, diverse initiatives to motivate staff, and continuously developing practices.Conclusions: Environmental responsibility extended throughout a hospital organization. Staff was in a key position to implement it, but they needed versatile organizational support, including education, clear procedures, defined roles, and a motivational culture and facilities.Implications for hospital management: This study yields new knowledge that will provide information for the development of organisational structures with respect to environmental responsibility in hospital care.

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Interviews with experts in rare diseases for the development of clinical decision support system software - a qualitative study

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-020-01254-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jannik Schaaf ◽

Hans-Ulrich Prokosch ◽

Martin Boeker ◽

Johanna Schaefer ◽

Jessica Vasseur ◽

...

Keyword(s):

Decision Support ◽

Qualitative Study ◽

Medical Informatics ◽

Clinical Decision Support ◽

Rare Diseases ◽

Qualitative Content Analysis ◽

Medical Center ◽

Clinical Decision ◽

Diagnostic Process ◽

University Hospitals

Abstract Background Patients with rare diseases (RDs) are often diagnosed too late or not at all. Clinical decision support systems (CDSSs) could support the diagnosis in RDs. The MIRACUM (Medical Informatics in Research and Medicine) consortium, which is one of four funded consortia in the German Medical Informatics Initiative, will develop a CDSS for RDs based on distributed clinical data from ten university hospitals. This qualitative study aims to investigate (1) the relevant organizational conditions for the operation of a CDSS for RDs when diagnose patients (e.g. the diagnosis workflow), (2) which data is necessary for decision support, and (3) the appropriate user group for such a CDSS. Methods Interviews were carried out with RDs experts. Participants were recruited from staff physicians at the Rare Disease Centers (RDCs) at the MIRACUM locations, which offer diagnosis and treatment of RDs. An interview guide was developed with a category-guided deductive approach. The interviews were recorded on an audio device and then transcribed into written form. We continued data collection until all interviews were completed. Afterwards, data analysis was performed using Mayring’s qualitative content analysis approach. Results A total of seven experts were included in the study. The results show that medical center guides and physicians from RDC B-centers (with a focus on different RDs) are involved in the diagnostic process. Furthermore, interdisciplinary case discussions between physicians are conducted. The experts explained that RDs exist which cannot be fully differentiated, but rather described only by their overall symptoms or findings: diagnosis is dependent on the disease or disease group. At the end of the diagnostic process, most centers prepare a summary of the patient case. Furthermore, the experts considered both physicians and experts from the B-centers to be potential users of a CDSS. The experts also have different experiences with CDSS for RDs. Conclusions This qualitative study is a first step towards establishing the requirements for the development of a CDSS for RDs. Further research is necessary to create solutions by also including the experts on RDs.

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HIV Medical Care Provider Practices for Reducing High-Risk Sexual Behavior: Results of a Qualitative Study

AIDS Patient Care and STDs ◽

10.1089/apc.2008.0063 ◽

2009 ◽

Vol 23 (5) ◽

pp. 347-356 ◽

Cited By ~ 25

Author(s):

Mari-Lynn Drainoni ◽

Debra Dekker ◽

Elizabeth Lee-Hood ◽

Ulrike Boehmer ◽

Michael Relf

Keyword(s):

Sexual Behavior ◽

High Risk ◽

Qualitative Study ◽

Medical Care ◽

Care Provider ◽

High Risk Sexual Behavior ◽

Provider Practices ◽

Risk Sexual Behavior

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Why do People Avoid Medical Care? A Qualitative Study Using National Data

Journal of General Internal Medicine ◽

10.1007/s11606-014-3089-1 ◽

2014 ◽

Vol 30 (3) ◽

pp. 290-297 ◽

Cited By ~ 59

Author(s):

Jennifer M. Taber ◽

Bryan Leyva ◽

Alexander Persoskie

Keyword(s):

Qualitative Study ◽

Medical Care ◽

National Data

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Influencing Factors of Intention and Behavior of Patient Delay in Elderly Benign Prostatic Hyperplasia: a Descriptive Qualitative Study

10.21203/rs.3.rs-1155453/v1 ◽

2022 ◽

Author(s):

Hao Zou ◽

Dong-xu Jiang ◽

Wan-yue Zhao ◽

Hong-hong Jia ◽

Ying-li Li ◽

...

Keyword(s):

Qualitative Study ◽

Medical Treatment ◽

Medical Care ◽

Influencing Factors ◽

Urban Areas ◽

Patient Delay ◽

Negative Evaluation ◽

Experienced Patient ◽

And Behavior ◽

Descriptive Qualitative

Abstract Background: Most elderly patients with BPH have experienced patient delay. Based on the TPB, the aim of this study was to describe the influencing factors of BPH patients' intention and behavior of patient delay and to provide a reference for the development of a patient delay intention scale and personalized intervention.Methods: This descriptive qualitative study was carried out 4 months in 2021 in China. The participants were 20 patients with BPH ages 60 to 82 years old who experienced patient delay and were selected through purposive sampling method. The study was performed in a large general hospital and a community hospital. The data were collected via face-to-face semi-structured interviews.Results: The following themes were relevant to BPH patients with intention and behavior of patient delay: “Insufficient cognition of symptoms (low symptom alertness, symptom benign attribution)”, “Experience coping instead of going to a doctor”, “Negative attitude toward seeking medical care (Underestimation of the consequences of delayed medical treatment, Negative evaluation of early medical treatment)”, “The influence of others on decision-making for seeking medical care(People who approve or disapprove of going to a doctor, Do or do not follow the opinions of others)”, “Obstacles to seeking medical care(Factors from the patient, Factors from medical institutions)”Conclusion: The delay was longer in rural areas than in urban areas. BPH patients' intention and behavior of patient delay are the result of a combination of many factors. Therefore, it is recommended to develop a scale to evaluate the patient delay intention for BPH, and provide personalized interventions based on the scale to improve patient delay in elderly BPH patients

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Evaluation of a Clinical Decision Support System for Rare Diseases - A Qualitative Study

10.21203/rs.3.rs-125710/v1 ◽

2020 ◽

Author(s):

Jannik Schaaf ◽

Martin Sedlmayr ◽

Brita Sedlmayr ◽

Hans-Ulrich Prokosch ◽

Holger Storf

Keyword(s):

Decision Support ◽

Qualitative Study ◽

Clinical Decision Support ◽

Rare Diseases ◽

Qualitative Content Analysis ◽

Clinical Decision ◽

Similarity Analysis ◽

University Hospitals ◽

Difficult Patient ◽

System Usability Scale

Abstract BackgroundRare Diseases (RDs) are difficult to diagnose. Clinical Decision Support Systems (CDSS) could support the diagnosis for RDs. The MIRACUM (Medical Informatics in Research and Medicine) consortium developed a CDSS for RDs based on distributed clinical data from ten German university hospitals. To support the diagnosis for difficult patient cases, the CDSS uses data from the different hospitals to perform a patient similarity analysis in order to obtain an indication of a diagnosis. To optimize our CDSS, we conducted this qualitative study to investigate the usability of the CDSS with its functionality and information included. Methods A Thinking Aloud Test (TA-Test) was performed with RDs experts recruited from Rare Diseases Centres (RDCs) at the MIRACUM locations which were specialized in the diagnosis and treatment of RDs.An instruction sheet with tasks was prepared that the participants should perform with the CDSS during the study. Participants were asked to share any thoughts about the CDSS. The TA-Test was recorded on audio and video. A questionnaire was handed out at the end of the study including the System Usability Scale (SUS). Afterwards, the data was analysed with the qualitative content analysis according to Mayring, which includes a category-guided deductive approach.ResultsA total of eight experts were included in the study since eight MIRACUM locations have established an RDC.The results show that more detailed information about the patients, such as descriptive attributes or findings, are needed. The given functionality of the CDSS was rated positively, such as the function for the overview of similar patients and medical history. However, there is a lack of transparency regarding the results of the CDSS patient similarity analysis. The participants stated that the system should present exactly which symptoms, diagnosis etc. have matched. Regarding usability, the CDSS received a score of 73.21 points according to the SUS, which is ranked as a good usability.ConclusionsThis qualitative study investigated the usability of a CDSS of RDs. Despite the promising results, the CDSS still needs some revisions before use in clinical practice, e.g. by improving the transparency of the patient similarity analysis.

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What do people with lung cancer and stroke expect from patient navigation? A qualitative study in Germany

BMJ Open ◽

10.1136/bmjopen-2021-050601 ◽

2021 ◽

Vol 11 (12) ◽

pp. e050601

Author(s):

Hella Fügemann ◽

Ute Goerling ◽

Kathrin Gödde ◽

Anke Kristin Desch ◽

Jacqueline Müller-Nordhorn ◽

...

Keyword(s):

Lung Cancer ◽

Qualitative Study ◽

Emotional Support ◽

Patient Navigation ◽

Qualitative Interview ◽

University Hospitals ◽

Patient Navigators ◽

Self Help ◽

Qualitative Interview Study ◽

Depth Interviews

ObjectiveThis qualitative study investigated patients’ needs and wishes in relation to patient navigation.DesignA qualitative interview study was conducted. Participants were invited to take part in three in-depth interviews over a period of 6–12 months. Thematic analysis was used.SettingInterviewees were sought in the Berlin metropolitan area of Germany in academic university hospitals, in rehabilitation clinics and through self-help organisations.ParticipantsThe sample consisted of individuals diagnosed with lung cancer (n=20) or stroke (n=20).ResultsFrom the perspective of interviewees, patient navigators should function as consistent contact persons, present during the whole care trajectory. Their role would be to guide patients through an often confusing healthcare landscape, offering practical, advisory and emotional assistance corresponding to patients’ needs. The study shows that—independent of the disease—participants had similar expectations and needs regarding support from navigators.ConclusionFor chronic and complex diseases—as is the case with lung cancer and stroke—it appears less important for navigators to fulfil disease-specific tasks. Rather, they should ensure that patients’ more general needs, in relation to social, practical and emotional support, are met in a way that suits their individual wishes. Following these results, patient navigation programmes might be designed to include generic elements, which should then be adapted to the infrastructure in a particular healthcare region and to the particularities of a specific healthcare system.

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