Health‐care professionals’ experiences of patient participation among older patients in intermediate care—At the intersection between profession, market and bureaucracy

Abstract Background and Objectives Deprescribing may be particularly relevant in older people with limited life expectancy. In order to effectively carry out deprescribing in this population, it is important to understand the perspectives of the full spectrum of health care professionals (HCPs) involved in the management of these patients’ medication. Thus, we aimed to explore different HCPs’ perspectives on deprescribing in older patients with limited life expectancy. Research Design and Methods Six qualitative focus group interviews were conducted using a semistructured approach. The groups comprised HCPs from both primary and secondary care, including family physicians (FPs), geriatricians, clinical pharmacologists, clinical pharmacists, nurses, and health care assistants. Interviews were audio recorded and transcribed verbatim. Results were analyzed using systematic text condensation. Results A total of 32 HCPs participated in the study (median age of 40.5 years; 22% male). The analysis elicited three main themes related to HCPs’ perspectives on deprescribing in older patients with limited life expectancy: (a) Approaching deprescribing, (b) Taking responsibility, and (c) Collaboration across professions. Within themes, subthemes were identified and analyzed. Discussion and Implications Our results imply that different groups of HCPs consider deprescribing an essential aspect of providing good care for older people with limited life expectancy and find that all HCPs play a crucial role in the deprescribing process, with FPs having the primary responsibility. In order to facilitate deprescribing among this population, however, the collaboration between different HCPs should be improved.

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Health Care Professionals and Family Involvement in Care-Related Decisions Concerning Older Patients

Journal of Aging and Health ◽

10.1177/089826439000200302 ◽

1990 ◽

Vol 2 (3) ◽

pp. 310-325 ◽

Cited By ~ 19

Author(s):

Gary T. Deimling ◽

Virginia L. Smerglia ◽

Charles M. Barresi

Keyword(s):

Health Care ◽

Family Involvement ◽

Health Care Professionals ◽

Older Patients

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Development and Evaluation of a Digital Intervention for Fulfilling the Needs of Older Migrant Patients With Cancer: User-Centered Design Approach (Preprint)

10.2196/preprints.21238 ◽

2020 ◽

Author(s):

Hande Sungur ◽

Nida Gizem Yılmaz ◽

Brittany Ming Chu Chan ◽

Maria E T C van den Muijsenbergh ◽

Julia C M van Weert ◽

...

Keyword(s):

Health Care ◽

Clinical Trials ◽

Patient Education ◽

Patient Participation ◽

Health Care Professionals ◽

Psychosocial Support ◽

Mother Tongue ◽

Patient Rights ◽

Ease Of Use ◽

Patients With Cancer

BACKGROUND Older migrant patients with cancer face many language- and culture-related barriers to patient participation during medical consultations. To bridge these barriers, an eHealth tool called Health Communicator was developed in the Netherlands. Essentially used as a digital translator that can collect medical history information from patients, the Health Communicator did not include an oncological module so far, despite the fact that the prevalence of Dutch migrant patients with cancer is rising. OBJECTIVE This study aims to systematically develop, implement, and conduct a pilot evaluation of an oncological module that can be integrated into the Health Communicator to stimulate patient participation among older Turkish-Dutch and Moroccan-Dutch patients with cancer. METHODS The Spiral Technology Action Research model, which incorporates 5 cycles that engage key stakeholders in intervention development, was used as a framework. The listen phase consisted of a needs assessment. The plan phase consisted of developing the content of the oncological module, namely the question prompt lists (QPLs) and scripts for patient education videos. On the basis of pretests in the do phase, 6 audiovisual QPLs on patient rights, treatment, psychosocial support, lifestyle and access to health care services, patient preferences, and clinical trials were created. Additionally, 5 patient education videos were created about patient rights, psychosocial support, clinical trials, and patient-professional communication. In the study phase, the oncological module was pilot-tested among 27 older Turkish-Dutch and Moroccan-Dutch patients with cancer during their consultations. In the act phase, the oncological model was disseminated to practice. RESULTS The patient rights QPL was chosen most often during the pilot testing in the study phase. Patients and health care professionals perceived the QPLs as easy to understand and useful. There was a negative correlation between the tool’s ease of use and patient age. Patients reported that using the module impacted the consultations positively and thought they were more active compared with previous consultations. Health care professionals also found patients to be more active than usual. Health care professionals asked significantly more questions than patients during consultations. Patients requested to see the patients’ rights video most often. Patients rated the videos as easy to understand, useful, and informative. Most of the patients wanted to use the tool in the future. CONCLUSIONS Older migrant patients with cancer, survivors, and health care professionals found the oncological module to be a useful tool and have shown intentions to incorporate it into future consultation sessions. Both QPLs and videos were evaluated positively, the latter indicating that the use of narratives to inform older, low-literate migrant patients with cancer about health-related topics in their mother tongue is a viable approach to increase the effectiveness of health care communication with this target group.

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Impact of participation on behaviour outcomes in health care service

Benchmarking An International Journal ◽

10.1108/bij-08-2016-0122 ◽

2017 ◽

Vol 24 (4) ◽

pp. 1082-1098 ◽

Cited By ~ 5

Author(s):

Sabita Mahapatra

Keyword(s):

Health Care ◽

Patient Participation ◽

Health Care Professionals ◽

Care Service ◽

Health Care Service ◽

Small Sample ◽

Primary Data ◽

Survey Method ◽

Cross Sectional ◽

Content Type

Purpose The purpose of this paper is to examine the effect of patient participation on patient satisfaction and the subsequent effect on patient behavior outcomes Design/methodology/approach The research employs self-administered survey method to test hypotheses. The convenience sampling approach is used to collected data from 410 patients in metropolitan cities of India. The data are analyzed using SmartPLS to test the proposed model. Findings The results shows patient participation is positively related to behaviour outcomes and patient confidence and satisfaction mediate the effect of patient participation on adherence. Research limitations/implications The study was limited to a small sample which may somewhat limit generalization of the findings. However, the findings, based on primary data, are insightful. Second, the current study was cross-sectional in nature, whereas a longitudinal study could had measured changes in perceptions over an extended time period. Practical implications The results provide interesting insights about the significance of patient participation in positive behavior outcome. These insights will enable health care professionals and government to formulate a suitable policy through which to encourage patient participation in health treatment regimes. Originality/value The paper demonstrates the influence of patient participation on behavior. There has been little research on this aspect in the Indian context to date, so this study offers an important guideline to the health care industry in relation to introducing customer empowerment into health care regimes.

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Development and Evaluation of a Digital Intervention for Fulfilling the Needs of Older Migrant Patients With Cancer: User-Centered Design Approach

Journal of Medical Internet Research ◽

10.2196/21238 ◽

2020 ◽

Vol 22 (10) ◽

pp. e21238

Author(s):

Hande Sungur ◽

Nida Gizem Yılmaz ◽

Brittany Ming Chu Chan ◽

Maria E T C van den Muijsenbergh ◽

Julia C M van Weert ◽

...

Keyword(s):

Health Care ◽

Clinical Trials ◽

Patient Education ◽

Patient Participation ◽

Health Care Professionals ◽

Psychosocial Support ◽

Mother Tongue ◽

Patient Rights ◽

Study Phase ◽

Patients With Cancer

Background Older migrant patients with cancer face many language- and culture-related barriers to patient participation during medical consultations. To bridge these barriers, an eHealth tool called Health Communicator was developed in the Netherlands. Essentially used as a digital translator that can collect medical history information from patients, the Health Communicator did not include an oncological module so far, despite the fact that the prevalence of Dutch migrant patients with cancer is rising. Objective This study aims to systematically develop, implement, and conduct a pilot evaluation of an oncological module that can be integrated into the Health Communicator to stimulate patient participation among older Turkish-Dutch and Moroccan-Dutch patients with cancer. Methods The Spiral Technology Action Research model, which incorporates 5 cycles that engage key stakeholders in intervention development, was used as a framework. The listen phase consisted of a needs assessment. The plan phase consisted of developing the content of the oncological module, namely the question prompt lists (QPLs) and scripts for patient education videos. On the basis of pretests in the do phase, 6 audiovisual QPLs on patient rights, treatment, psychosocial support, lifestyle and access to health care services, patient preferences, and clinical trials were created. Additionally, 5 patient education videos were created about patient rights, psychosocial support, clinical trials, and patient-professional communication. In the study phase, the oncological module was pilot-tested among 27 older Turkish-Dutch and Moroccan-Dutch patients with cancer during their consultations. In the act phase, the oncological model was disseminated to practice. Results The patient rights QPL was chosen most often during the pilot testing in the study phase. Patients and health care professionals perceived the QPLs as easy to understand and useful. There was a negative correlation between the tool’s ease of use and patient age. Patients reported that using the module impacted the consultations positively and thought they were more active compared with previous consultations. Health care professionals also found patients to be more active than usual. Health care professionals asked significantly more questions than patients during consultations. Patients requested to see the patients’ rights video most often. Patients rated the videos as easy to understand, useful, and informative. Most of the patients wanted to use the tool in the future. Conclusions Older migrant patients with cancer, survivors, and health care professionals found the oncological module to be a useful tool and have shown intentions to incorporate it into future consultation sessions. Both QPLs and videos were evaluated positively, the latter indicating that the use of narratives to inform older, low-literate migrant patients with cancer about health-related topics in their mother tongue is a viable approach to increase the effectiveness of health care communication with this target group.

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Patient Centered Professionalism? Patient Participation in Mental Health Professional Frameworks

Professions and Professionalism ◽

10.7577/pp.1474 ◽

2016 ◽

Vol 6 (2) ◽

pp. e1474 ◽

Cited By ~ 1

Author(s):

Aukje Leemeijer ◽

Margo Trappenburg

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Care ◽

Social Workers ◽

Mental Health Professionals ◽

Patient Participation ◽

Health Professionals ◽

Health Care Professionals ◽

Codes Of Conduct ◽

Patient Centered

Patient participation is an important development in Dutch mental health care. Notwithstanding a generally positive attitude towards patient participation, mental health professionals show ambivalent responses to it due to tensions that may occur between professional values and societal values like (more) patient participation. Professionals vary in their degree of professionalization which is translated to their formal professional frameworks like professional profiles and codes of conduct. To explore how formal professional frameworks of mental health professionals mirror how and to what degree they accommodate patient participation the professional frameworks of four types of mental health care professionals were studied: psychiatrists, psychologists, nurses, and social workers. We hypothesized that the higher professionalized professions were less open to patient participation. The results partly support this hypothesis. Professional frameworks of social workers and nurses indeed show more openness to patient participation, but the picture for psychiatrists and psychologists is ambiguous—more professionalized psychiatrists being more inclined to incorporate patient participation than less professionalized psychologists.

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The effect of a telephone follow-up call for older patients, discharged home from the emergency department on health-related outcomes: a systematic review of controlled studies

International Journal of Emergency Medicine ◽

10.1186/s12245-021-00336-x ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Merel van Loon-van Gaalen ◽

Britt van Winsen ◽

M. Christien van der Linden ◽

Jacobijn Gussekloo ◽

Roos C. van der Mast

Keyword(s):

Health Care ◽

Emergency Department ◽

Health Care Professionals ◽

Older Patients ◽

Transitional Care ◽

Intervention Group ◽

Living Environment ◽

Increased Risk ◽

Health Related

Abstract Background Older patients discharged from the emergency department (ED) are at increased risk for adverse outcomes. Transitional care programs offer close surveillance after discharge, but are costly. Telephone follow-up (TFU) may be a low-cost and feasible alternative for transitional care programs, but its effects on health-related outcomes are not clear. Aim We systematically reviewed the literature to evaluate the effects of TFU by health care professionals after ED discharge to an unassisted living environment on health-related outcomes in older patients compared to controls. Methods We conducted a multiple electronic database search up until December 2019 for controlled studies examining the effects of TFU by health care professionals for patients aged ≥65 years, discharged to an unassisted living environment from a hospital ED. Two reviewers independently assessed eligibility and risk of bias. Results Of the 748 citations, two randomized controlled trials (including a total of 2120 patients) met review selection criteria. In both studies, intervention group patients received a scripted telephone intervention from a trained nurse and control patients received a patient satisfaction survey telephone call or usual care. No demonstrable benefits of TFU were found on ED return visits, hospitalization, acquisition of prescribed medication, and compliance with follow-up appointments. However, many eligible patients were not included, because they were not reached or refused to participate. Conclusions No benefits of a scripted TFU call from a nurse were found on health services utilization and discharge plan adherence by older patients after ED discharge. As the number of high-quality studies was limited, more research is needed to determine the effect and feasibility of TFU in different older populations. PROSPERO registration number CRD42019141403.

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Improving health care professionals’ collaboration to facilitate patient participation in decisions regarding life-prolonging care: An action research project

Journal of Interprofessional Care ◽

10.3109/13561820.2015.1027335 ◽

2015 ◽

Vol 29 (5) ◽

pp. 409-414 ◽

Cited By ~ 7

Author(s):

Julia Sohi ◽

Manon Champagne ◽

Sarah Shidler

Keyword(s):

Health Care ◽

Action Research ◽

Patient Participation ◽

Health Care Professionals ◽

Action Research Project ◽

Research Project ◽

Improving Health Care

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Older Patients in Emergency Departments. Challenges from the health care providers’ perspective

European Journal of Public Health ◽

10.1093/eurpub/ckz187.179 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

J Deutschbein ◽

M Möckel ◽

L Schenk

Keyword(s):

Health Care ◽

Adverse Events ◽

Health Care Providers ◽

Demographic Change ◽

Health Care Professionals ◽

Emergency Departments ◽

Older Patients ◽

Care Providers ◽

Complex Needs ◽

Prolonged Length

Abstract Background Patients aged 65 and above are the fastest growing patient population in Europe. This is one of greatest challenges for almost all health services providers, including acute hospitals and their Emergency Departments (ED). As of today, older patients represent up to 30% of all ED patients, it is estimated. However, it is largely unclear to what degree EDs are currently prepared for older patients and how they need to adjust. This study analyses the present situation from the perspective of health care professionals caring for older ED patients. Methods The study was embedded in a mixed methods design using qualitative expert interviews. N = 25 semi-structured, guided interviews were conducted with professional health care providers from 7 Berlin EDs (physicians, nurses), and adjacent health care sectors such as nursing homes, rehabilitation clinics, and medical practices. Interviewees were asked about their daily experiences with older ED patients and their ideas of health care deficits and potentials. Data was analyzed using content analysis and hermeneutics. Results Health care providers assess the ED care situation for older patients and the necessity of adjustments in different ways but mostly as deficient. EDs are described as not elderly-friendly and partly as hazardous: older patients are at risk of adverse events such as developing a delirium. Risk factors are prolonged length of stay, the busy and noisy ED setting, and falls hazards. In general, ED staffing is not adequate to care for older patients with complex needs. Conclusions Considering demographic change, German Eds need to concentrate on the growing number of oder patients and their specific needs. Further research and development of specific care concepts for older ED patients is strongly needed. Potential adjustments of ED structures and care concepts also need to involve patients’ experiences and subjective needs. However, data on the patient perspective is still missing. Key messages Older patients and demographic change represent great challenges for EDs. Care concepts need to be developed to meet older patients needs and to avoid risks of adverse events.

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