Non-adherence in difficult-to-treat rheumatoid arthritis from the perspectives of patients and rheumatologists: a concept mapping study

Abstract Objectives Treatment non-adherence is more frequent among difficult-to-treat (D2T) than among non-D2T RA patients. Perceptions of non-adherence may differ. We aimed to thematically structure and prioritize barriers to (i.e. causes and reasons for non-adherence) and facilitators of optimal adherence from the patients’ and rheumatologists’ perspectives. Methods Patients’ perceptions were identified in semi-structured in-depth interviews. Experts selected representative statements regarding 40 barriers and 40 facilitators. Twenty D2T and 20 non-D2T RA patients sorted these statements during two card-sorting tasks: first, by order of content similarity and, second, content applicability. Additionally, 20 rheumatologists sorted the statements by order of content applicability to the general RA population. The similarity sorting was used as input for hierarchical cluster analysis. The applicability sorting was analysed using descriptive statistics, prioritized and the results compared between D2T RA patients, non-D2T RA patients and rheumatologists. Results Nine clusters of barriers were identified, related to the healthcare system, treatment safety/efficacy, treatment regimen and patient behaviour. D2T RA patients prioritized adverse events and doubts about effectiveness as the most important barriers. Doubts about effectiveness were more important to D2T than to non-D2T RA patients (P = 0.02). Seven clusters of facilitators were identified, related to the healthcare system and directly to the patient. All RA patients and rheumatologists prioritized a good relationship with the healthcare professional and treatment information as the most helpful facilitators. Conclusions D2T RA patients, non-D2T RA patients and rheumatologists prioritized perceptions of non-adherence largely similarly. The structured overviews of barriers and facilitators provided in this study may guide improvement of adherence.

Download Full-text

Expanding Fiscal Space for Healthcare System through Efficiency: A Qualitative Study from Iran

Iranian Journal of Public Health ◽

10.18502/ijph.v49i4.3180 ◽

2020 ◽

Author(s):

Firoozeh BAIRAMI ◽

Amirhossein TAKIAN ◽

Ali AKBARI SARI ◽

Iraj HARIRCHI ◽

Minoo ALIPOURI SAKHA

Keyword(s):

Qualitative Study ◽

Healthcare System ◽

Mixed Method ◽

Qualitative Content Analysis ◽

Healthcare Systems ◽

Limited Resources ◽

Feasible Option ◽

Fiscal Space ◽

Depth Interviews ◽

Initial Framework

Background: Healthcare systems are always facing increasing public demands to provide better services. Therefore, countries always need more resources and are constantly seeking more fiscal space for health. Freeing up resources through improving efficiency can be a practical option for all settings, particularly countries with low resources. This study aimed to identify feasible options for expanding fiscal space through efficiency within Iran’s healthcare system. Methods: This was a qualitative study. We conducted 29 semi-structured in-depth interviews with stakeholders at various levels of healthcare system in 2017 and 2018. We used mixed method (deductive and inductive) qualitative content analysis. Pre-defined themes extracted from literature and meanwhile new subthemes were developed and added to the initial framework. Results: We identified three main themes that affect the efficiency of healthcare system in Iran: administration, implementation, and monitoring. Problematic administration, inappropriate implementation and lack of good monitoring in healthcare initiatives may lead to inefficiencies and wasting resources. Recognizing these leakages in every healthcare system can free up some resources. Conclusion: Irrespective of their economic development, all countries may, to some extent, face limited resources to address ever-increasing needs in their healthcare systems. While generating new resources is not always possible, enhancing efficiency to expand fiscal space might be a feasible option. Healthcare systems should identify the leakages and respond to wastages with appropriate planning. Getting the most out of current resources is possible through proper administration, good implementation and a well-established monitoring system for healthcare initiatives.

Download Full-text

Traditional usage of medicinal plants by Temiar tribes in the State of Kelantan, Peninsular Malaysia

Forest and Society ◽

10.24259/fs.v3i2.6424 ◽

2019 ◽

Vol 3 (2) ◽

pp. 227

Author(s):

Pakhriazad Hassan Zaki ◽

Seca Gandaseca ◽

Noorhayati Mohd Rashidi

Keyword(s):

Medicinal Plants ◽

Medicinal Plant ◽

Traditional Medicine ◽

Healthcare System ◽

Plant Species ◽

Rural Community ◽

Peninsular Malaysia ◽

Cultural Roots ◽

Depth Interviews ◽

Structured Questionnaire

Traditional medicine has deep historical linkages and cultural roots. In a rural community, it is practice based on the ethnological, medical and heritage of the practitioners. Temiar indigenous tribe of Orang Asli in Kelantan, have their traditional way of beliefs and healing practices. This study examines the remedies using medicinal plants and herbs among the tribe members in Kampung Pasik, Kelantan, Malaysia. A structured questionnaire and in-depth interviews were conducted with 250 respondents. A total of 18 species of medicinal plants was recorded preferably used by the tribes. Results indicate that traditional phytoremedies practices play an important role in helping their healthcare system with the help of the tribe healers. Cultivated medicinal plant species represent 94% of the source, whereas 4.4% were found wild in the forest and 1.6% grown around their settlement. This study revealed that five preparations methods such as boiling (27.56%), pounded (27.45%), squeeze (21.60%), drying (14.17%) or concoction of various part of medicinal plants (9.22%). The most applied were by drinking (35.29%), chewing (32.70%) and 19.89% rubbing, poultice (6.40%) and shower ingredients (5.72%).

Download Full-text

Adolescents and Young Adults Knowledge, Adherence and Experiences While on Antiretroviral Therapy in a Tertiary Hospital in Lagos, Nigeria: A Mixed-Method Study

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/23259582211062754 ◽

2021 ◽

Vol 20 ◽

pp. 232595822110627

Author(s):

Roseline Iberi Aderemi-Williams ◽

Ayomikun Rofiat Razaq ◽

Isaac Okoh Abah ◽

Olabisi Oluranti Opanuga ◽

Alani Sulaimon Akanmu

Keyword(s):

Young Adults ◽

Mixed Method ◽

Knowledge Score ◽

Tertiary Hospital ◽

Adolescents And Young Adults ◽

University Teaching ◽

Mixed Method Study ◽

Social Support Systems ◽

Depth Interviews ◽

Optimal Adherence

In Nigeria, there is a paucity of data on knowledge and experiences of adolescents and young adults (AYAs) with HIV and ART, as well as their challenges maintaining optimal adherence. A mixed-method study was carried out between August and September 2018 among AYAs attending Lagos University Teaching Hospital, Nigeria. Data collection was via AYAs' hospital records, standardized questionnaires, and in-depth interviews (IDIs). The 4-day ACTG tool was used to measure adherence. Collected data were analyzed descriptively. Assessment of 34 AYAs comprising 18 (52.9%) males with 28 (82.4%) students revealed an overall knowledge score about ART and its effect of 73.6%. Twenty-five (73.5%) had poor knowledge of the development of resistant strains of HIV due to non-adherence recorded. Optimal adherence (≥95%) was recorded in 20 (58.8%) AYAs. IDI produced 4 themes: (i) reasons for non-adherence, (ii) ensuring optimal adherence, (iii) Social support systems and disclosure, and (iv) stigmatization. Our study provided formative data and revealed areas for intervention to improve knowledge and adherence to ART.

Download Full-text

Models of Physician’s Behavior in the Situation of Assignment Paid Procedures

Inter ◽

10.19181/inter.2021.13.1.2 ◽

2021 ◽

Vol 13 (1) ◽

pp. 40-62

Author(s):

Ekaterina Andreeva

Keyword(s):

Grounded Theory ◽

Social Norms ◽

Healthcare System ◽

Working Conditions ◽

Personal Values ◽

Complex Combination ◽

Therapeutic Services ◽

Depth Interviews

The Russian healthcare system provides a set of free and paid diagnostic and therapeutic services. Although, when prescribing additional paid services, a specific doctor is provided with the situation of choice. The doctor is faced with a set of ethical and professional motivators, one of which is paid services as a source of additional medical income. What do doctors do in this situation, what strategies do they choose and what motivates their decision? Conducted and analyzed in-depth interviews (18 interviews, Tver, 2018) with doctors of different specialties revealed several patterns of doctor’s behavior when prescribing paid services. The data analyzed in the tactics of grounded theory allowed the author to build several models of doctor’s behavior, where such choices are associated with certain system of professional and personal values. The described models are conventionally named by author: “Making money”, “Polypragmasia”, “Collegiality”, “Man-System”, “One and a half rates”, “Out of the system”, “Avoidance”.The constructed models of behavior of doctors show that the appointment of additional optional procedures is associated not only with the doctor's desire to earn money, but also can be explained by a more complex combination of reasons, working conditions, formal and informal social norms, as well as the basic values of the doctors themselves.

Download Full-text

In search of healthcare system ideal types — Changeable classifications and dimensions

Finnish Journal of Social Research ◽

10.51815/fjsr.108062 ◽

2021 ◽

Vol 14 ◽

Author(s):

Iris Moolla ◽

Heikki Hiilamo ◽

Antti Kouvo

Keyword(s):

Health System ◽

Healthcare System ◽

Hierarchical Cluster ◽

Healthcare Systems ◽

Three Dimensions ◽

Healthcare Provision ◽

Ideal Types ◽

Developed Economies ◽

And Performance ◽

System Characteristics

This article aims to classify the healthcare systems of 43 developed economies into different healthcare system types, and to examine whether the dimensions of health system characteristics produce coherent health system classification when the dimensions are observed separately. We group health systems into different types based on their institutional structures and performance using healthcare financing, healthcare provision and health outcomes as dimensions of the health system characteristics. Unlike previous classifications, we classify each dimension separately using hierarchical cluster analysis. In particular dimensions, our results resemble those found in previous classifications. However, no coherent clustering of healthcare systems was found across the three dimensions. The results show that healthcare system dimensions differ from each other and each of them form their unique system types. Separating the dimensions helps detecting connections between the healthcare system types and phenomena being studied. It is relevant to note the differences of health system dimensions while discussing healthcare system classifications.

Download Full-text

(A228) Evaluation of the “Health Legal Preparedness” Model in the Context of Emergency Response in Israel

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11002147 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s62-s62

Author(s):

O. Cohen ◽

P. Feder-Bubis ◽

Y. Bar-Dayan

Keyword(s):

Health System ◽

Healthcare System ◽

Emergency Response ◽

Emergency Preparedness ◽

Optimal Operation ◽

The Us ◽

Health Related ◽

Emergency Systems ◽

State Of Affairs ◽

Depth Interviews

BackgroundThe “Health Legal Preparedness Model” developed in the US aims to provide better health-related responses in times of emergency. It includes four components: (1) law; (2) competencies; (3) information; and (4) coordination.ObjectiveThe aim of this study is to examine the usefulness of the “Health Legal Preparedness Model” in the present state of affairs in the field of emergency preparedness in Israel.MethodsA qualitative study was conducted. In-depth interviews were performed with leading experts in the past or at present in the Israeli emergency health system.ResultsThe Israeli healthcare system already has elements of the model in place at various levels. The relative perceived importance of each of the four aspects of the model varied between the experts. Of the four components, law and coordination were perceived as a major system concern. Training of specialists in emergency legislation was controversial. In addition, differences were found in the experts' perceptions as of the optimal way to operate the health system during an emergency. Variability also was found in the perception of the private sector growth and in the importance of its incorporation into emergency response plans. The study found that the emergency preparedness system resembles military practices in its conduct. Nevertheless, there is willingness toward mutual emergency systems drills, including aspects of legal preparedness.ConclusionsThe model already is applied partially in the Israeli emergency healthcare system. Results indicate that the Health Legal Preparedness Model might be useful in identifying gaps in emergency response plans. It also crystallized gaps related to optimal operation during emergencies in the country. Therefore, it is important to reach agreement upon solutions that will incorporate a regulatory guideline in order to improve the function of the emergency healthcare system.

Download Full-text

Readiness in HIV Treatment Adherence: A Matter of Confidence. An Exploratory Study§

The Open AIDS Journal ◽

10.2174/1874613601105010119 ◽

2011 ◽

Vol 5 (1) ◽

pp. 119-124 ◽

Cited By ~ 6

Author(s):

Helene Sylvain ◽

Philippe Delmas

Keyword(s):

Treatment Adherence ◽

Life Events ◽

Exploratory Study ◽

Active Role ◽

Hiv Treatment ◽

Adherence To Treatment ◽

Data Collection Process ◽

Professional Perspectives ◽

Depth Interviews ◽

Optimal Adherence

Adherence to treatment is recognized as the essence of a successful HIV combination therapy. Optimal adherence implies a readiness to begin the treatment on the part of the patient. A better understanding of the "readiness phenomenon" will become an asset for optimizing HIV treatment. However, few studies have focused on understanding the process underlying the choice to adhere. The aim of this study is to understand the readiness process that leads to adhering to the HIV treatment, from both patient and professional perspectives. Twenty-seven in-depth interviews, with a qualitative exploratory design, were the source of our data. Participants were recruited in two hospitals in Paris. Throughout the data-collection process, analysed data were supplied to all participants and the research team, thus allowing for shared constructions. Four themes, interrelated with a constitutive pattern, emerged from the data we collected. Being ready to begin and adhere to treatment is a matter of confidence in oneself, as well as in relatives, in the treatment and in the health professional team. These themes are not constant and unvarying; instead, they constitute a picture moving across time and life events. Results of this study show that adherence that goes beyond “complying with” the medical instructions, but depends on how much of an active role the patient plays in the choice to adhere.

Download Full-text

Models of Physician’s Behavior in the Situation of Assignment Paid Procedures

Inter ◽

10.19181/nter.2021.13.1.2 ◽

2021 ◽

Vol 13 (1) ◽

pp. 40-62

Author(s):

Ekaterina Andreeva

Keyword(s):

Grounded Theory ◽

Social Norms ◽

Healthcare System ◽

Working Conditions ◽

Personal Values ◽

Complex Combination ◽

Therapeutic Services ◽

Depth Interviews

Download Full-text

Enhancing shared decision making about discontinuation of antidepressant medication: a concept-mapping study in primary and secondary mental health care

British Journal of General Practice ◽

10.3399/bjgp19x706001 ◽

2019 ◽

Vol 69 (688) ◽

pp. e777-e785 ◽

Cited By ~ 5

Author(s):

Carolien Wentink ◽

Marloes J Huijbers ◽

Peter LBJ Lucassen ◽

Annoek van der Gouw ◽

Cornelis Kramers ◽

...

Keyword(s):

Decision Making ◽

Concept Mapping ◽

Shared Decision Making ◽

Antidepressant Medication ◽

Hierarchical Cluster ◽

Decision Making Process ◽

Shared Decision ◽

Mapping Study ◽

Professional Guidance

BackgroundThe apparent rise of antidepressant use seems to be explained to a large extent by an increase in long-term use. Both professionals and patients appear reluctant to discontinue antidepressant medication (ADM). It is not known what factors determine this reluctance.AimThis study aimed to identify factors that enable the shared decision-making process about discontinuation of ADM between long-term users and their GPs.Design and settingConcept-mapping study of a purposive sample of both patients and professionals from primary and secondary mental health care in the Netherlands.MethodConcept mapping was used to conceptualise and structure the topics relevant to the discontinuation process from the perspective of both patients and professionals. Participants generated topics in brainstorming sessions and subsequently prioritised and sorted them. Multidimensional scaling and hierarchical cluster analyses were used for the cluster topics.ResultsThirty-seven patients and 27 professionals generated 50 separate topics. Hierarchical cluster analysis revealed six clusters of topics: ‘Process of discontinuation’, ‘Expectations’, ‘Professional guidance’, ‘Current use’, ‘Environment’, and ‘Side effects’. Patients and professionals came up with largely similar topics. Nevertheless, a difference was found between these groups regarding the perceived importance of professional guidance.ConclusionThis study yielded an informed selection of the topics that seem most important to discuss when considering whether to discontinue ADM. As perspectives of both patients and professionals were combined, the topics may provide patients and GPs with a broader and more balanced scope of factors to consider, and thus facilitate a better shared decision-making process.

Download Full-text

Child and Parent Perceived Determinants of Children’s Inadequate Sleep Health. A Concept Mapping Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17051583 ◽

2020 ◽

Vol 17 (5) ◽

pp. 1583 ◽

Cited By ~ 4

Author(s):

Laura Belmon ◽

Vincent Busch ◽

Maartje van Stralen ◽

Dominique Stijnman ◽

Lisan Hidding ◽

...

Keyword(s):

Concept Mapping ◽

Affective State ◽

Hierarchical Cluster ◽

Well Being ◽

Stressful Situation ◽

Mapping Study ◽

Negative Effects ◽

Sleep Habits ◽

Children And Parents ◽

Inadequate Sleep

Many children do not meet the recommendations for healthy sleep, which is concerning given the potential negative effects on children’s health. To promote healthy sleep, it is crucial to understand its determinants. This concept mapping study therefore explores perspectives of children and parents on potential determinants of children’s inadequate sleep. The focus lies on 9–12 year old children (n = 45), and their parents (n = 33), from low socioeconomic neighbourhoods, as these children run a higher risk of living in a sleep-disturbing environment (e.g., worries, noise). All participants generated potential reasons (i.e., ideas) for children’s inadequate sleep. Next, participants sorted all ideas by relatedness and rated their importance. Subsequently, multidimensional scaling and hierarchical cluster analyses were performed to create clusters of ideas for children and parents separately. Children and parents both identified psychological (i.e., fear, affective state, stressful situation), social environmental (i.e., sleep schedule, family sleep habits), behavioural (i.e., screen behaviour, physical activity, diet), physical environmental (i.e., sleep environment such as temperature, noise, light), and physiological (i.e., physical well-being) determinants. These insights may be valuable for the development of future healthy sleep interventions.

Download Full-text