scholarly journals Mixed methods study of clinicians’ perspectives on barriers to implementation of treat to target in psoriatic arthritis

2020 ◽  
Vol 79 (8) ◽  
pp. 1031-1036 ◽  
Author(s):  
Emma Dures ◽  
Julie Taylor ◽  
Sasha Shepperd ◽  
Sandeep Mukherjee ◽  
Joanna Robson ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Psoriatic Arthritis ◽  
Focus Group ◽  
Online Survey ◽  
Service Providers ◽  
Integrated Approach ◽  
Outcome Data ◽  
Treat To Target ◽  
It Systems ◽  
Patient Reported

ObjectivesIn treat to target (T2T), the patient is treated to reach and maintain specified and sequentially measured goals, such as remission or low disease activity. T2T in psoriatic arthritis (PsA) has demonstrated improved clinical and patient-reported outcomes and is recommended in European guidelines. However, most clinicians do not use T2T in PsA. This study examined the barriers and enablers to implementation in practice.MethodsSequential mixed methods comprising a qualitative design (interviews and focus group) to inform a quantitative design (survey). Qualitative data were analysed thematically, and quantitative statistics were analysed descriptively.ResultsNineteen rheumatology clinicians participated in telephone interviews or a face-to-face focus group. An overarching theme ‘Complexity’ (including ‘PsA vs Rheumatoid Arthritis’, ‘Measurement’ and ‘Resources’) and an underpinning theme ‘Changes to current practice’ (including ‘Reluctance due to organisational factors’ and ‘Individual determination to make changes’) were identified. 153 rheumatology clinicians responded to an online survey. Barriers included limited clinical appointment time to collect outcome data (54.5%) and lack of training in assessing skin disease (35%). Enablers included provision of a protocol (86.4%), a local implementation lead (80.9%), support in clinic to measure outcomes (83.3%) and training in T2T (69.8%). The importance of regular audit with feedback, specialist PsA clinics and a web-based electronic database linked to hospital/national information technology (IT) systems were also identified as enablers.ConclusionsImplementation of T2T in PsA requires an integrated approach to address the support, training and resource needs of individual clinicians, rheumatology teams, local IT systems and service providers to maximise success.

scholarly journals Experiences of telehealth e-mentoring within postgraduate musculoskeletal physical therapy education in the UK and Canada: a protocol for parallel mixed-methods studies and cross-cultural comparison

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e042602
Author(s):  
Nicola R Heneghan ◽  
Madeleine Nazareth ◽  
Wendy J Johnson ◽  
Isaak Tyros ◽  
Jackie Sadi ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Physical Therapy ◽  
Focus Group ◽  
Outcome Data ◽  
Cross Cultural ◽  
Cultural Comparison ◽  
Physical Therapy Education ◽  
Cross Cultural Comparison ◽  
Patient Reported ◽  
Therapy Education

IntroductionMentored clinical practice is central to demonstrating achievement of International Educational Standards in advanced musculoskeletal physical therapy. While traditionally delivered face-to-face, telehealth e-mentoring is a novel alternative to offering this unique pedagogy to facilitate mentee critical reflection, deeper learning and enhanced knowledge translation to optimise patient care. With COVID-19 resulting in widespread adoption of telehealth and access to mentors often limited by geography or cost, the potential value of telehealth e-mentoring needs investigating. To investigate the experiences and outcomes of multiple stakeholders (student mentees, mentors and patients) engaged in musculoskeletal physical therapy telehealth e-mentoring across two universities (UK and Canada).Methods and analysisUsing case study design, we will use sequential mixed methods involving qualitative and quantitative components based on existing evidence. To examine the influence of telehealth e-mentoring on health outcomes in patients with musculoskeletal complaints, we will use patient-reported outcomes for satisfaction, patient empowerment and change in musculoskeletal health. We will conduct semistructured interviews to explore the development of critical thinking, clinical reasoning, communication skills and confidence of students engaged in telehealth e-mentoring. To explore the mentor acceptability and appropriateness of telehealth e-mentoring, we will conduct a focus group in each site. Finally, we will include a focus group of participants from each site to allow a cross-cultural comparison of findings to inform international stakeholders. Quantitative data will be analysed using descriptive statistics (median and IQR) to describe changes in outcome data and qualitative data will be analysed following the Framework Method.Ethics and disseminationThis study has ethical approval from both institutions: the University of Birmingham (ERN_20-0695) and Western University (2020-116233-47832). Findings will be published in a peer-reviewed journal and disseminated to key stakeholders in musculoskeletal physical therapy education and practice.

scholarly journals Engagement with and delivery of the ‘parkrun practice initiative’ in general practice: a mixed methods study

2020 ◽  
Vol 70 (697) ◽  
pp. e573-e580
Author(s):  
Joanna Fleming ◽  
Carol Bryce ◽  
Joanne Parsons ◽  
Chrissie Wellington ◽  
Jeremy Dale
Keyword(s):  
General Practice ◽  
Mixed Methods ◽  
Focus Group ◽  
Online Survey ◽  
Mixed Methods Study ◽  
Structured Interviews ◽  
Practice Staff ◽  
Health And Wellbeing ◽  
Positive Effects ◽  
Improve Patient

BackgroundThe parkrun practice initiative, a joint collaboration between parkrun and the Royal College of General Practitioners, was launched to encourage general practices to improve the health and wellbeing of patients and staff through participating in local 5 km parkrun events. Why and how practices engage with the initiative is unknown.AimTo investigate engagement with and delivery of the parkrun practice initiative in general practice.Design and settingMixed methods study conducted from April–July 2019 comprising an online survey of all registered parkrun practices, and interviews and a focus group with practice staff in the West Midlands.MethodThe designated contacts at 780 registered parkrun practices were invited to complete an online survey. A purposive sample of parkrun practice staff and non-registered practice staff took part either in semi-structured interviews or a focus group, with transcripts analysed thematically.ResultsOf the total number of parkrun practices, 306 (39.2%) completed the survey. Sixteen practice staff (from nine parkrun practices and four non-registered practices) took part in either semi-structured interviews (n = 12) or a focus group (n = 4). Key motivators for becoming a parkrun practice were: to improve patient and staff health and wellbeing, and to become more engaged with the community and enhance practice image. Practices most commonly encouraged patients, carers, and staff to take part in parkrun and displayed parkrun flyers and posters. Challenges in implementing activities included lack of time (both personal and during consultations) and getting staff involved. Where staff did engage there were positive effects on morale and participation. Non-registered practices were receptive to the initiative, but had apprehensions about the commitment involved.ConclusionPractices were keen to improve patient and staff health. Addressing time constraints and staff support needs to be considered when implementing the initiative.

scholarly journals Barriers to treatment optimization and achievement of patients’ goals: perspectives from people living with rheumatoid arthritis enrolled in the ArthritisPower registry

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Kelly Gavigan ◽  
W. Benjamin Nowell ◽  
Mylene S. Serna ◽  
Jeffrey L. Stark ◽  
Mohamed Yassine ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Online Survey ◽  
Treatment Decisions ◽  
Treat To Target ◽  
Measurement Information ◽  
Treatment Goals ◽  
Barriers To Treatment ◽  
Treatment Optimization ◽  
Patient Reported

Abstract Background Few studies have investigated patients’ own treatment goals in rheumatoid arthritis (RA). The objective of this real-world, cross-sectional study of US patients with RA was to identify factors that patients believed influenced their physician’s treatment decisions. Secondary objectives included reasons patients tolerated sub-optimal disease control and their perceived barriers to treatment optimization. Methods Eligible participants were enrolled in the ArthritisPower registry, ≥ 19 years, had physician-diagnosed RA, unchanged treatment within 3 months of baseline, prior/current disease-modifying antirheumatic drug treatment (DMARDs), and computer/smartphone access. In December 2017, participants completed Patient-Reported Outcomes Measurement Information System-Computerized Adaptive Tests (PROMIS-CAT) for pain interference, fatigue, sleep disturbance, and physical function. Routine Assessment of Patient Index Data 3 (RAPID3) provided disease activity scores (0–30). Participants completed an online survey on barriers to treatment optimization, including self-perception of disease compared to RAPID3/PROMIS scores. Results A total of 249 participants met inclusion criteria and completed the survey. Mean age (SD) was 52 (11) years, and the majority were female (92%) with high RAPID3 disease activity (175/249 [70%]; median score 18). The main reason participants did not change treatment was their physician’s recommendation (66%; n = 32). Of participants with high RAPID3 disease activity, 66 (38%) were offered a treatment change; 19 (29%) of whom declined the change. Most participants who intensified treatment did so because their symptoms had remained severe or worsened (51%; n = 33); only 16 (25%) participants intensified because they had not reached a specified treatment goal. Among participants who self-reported their disease activity as “none/low” or “medium” (n = 202; 81% of cohort), most still had RAPID3 high disease activity (137/202 [68%]; score > 12). Most PROMIS scores showed moderate agreement with participants’ self-assessment of health status, in contrast to RAPID3 (weighted kappa: 0.05 [95% CI − 0.01, 0.11]). Conclusions Most participants trusted their rheumatologist’s treatment decisions and prioritized their physician’s treatment goals over their own. Patients should be encouraged to share their treatment goals/expectations with their rheumatologist, in line with the treat-to-target approach. RAPID3 may be inappropriate for setting patient-centric treatment goals given the poor agreement with self-reported disease activity; most PROMIS scores showed better alignment with patients’ own assessments.

Mixed-methods study of integration of housing and medical data systems for enhanced service coordination of people with HIV

2020 ◽  
Vol 23 (1) ◽  
pp. 43-51 ◽  
Author(s):  
Vivian L Towe ◽  
Laura Bogart ◽  
Ryan McBain ◽  
Lisa Wagner ◽  
Clare Stevens ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Focus Group ◽  
Data Integration ◽  
Service Providers ◽  
Data System ◽  
Primary Data ◽  
Service Coordination ◽  
Data Systems ◽  
Care Providers ◽  
Two Systems

Introduction Housing is a determinant of HIV-related medical outcomes. Care coordination has been successfully used to treat patients with HIV and can be improved through electronic exchange of patient data, including housing data. Methods Primary data were collected from four sites across the U.S., each comprising partnerships between local HIV medical and housing providers. Between March 2017 and May 2018, we conducted a mixed-methods evaluation, focusing on preparatory activities, implementation of tasks related to data integration, and service coordination. Nineteen focus group discussions were conducted with providers, organizational leaders, and clients. Ten interviews were conducted with data system vendors and administrators. Site visits, logs, and progress reports provided information about data integration progress and other activities. Results Key activities included changes to client consent, setting up data use agreements, and planning with data system vendors. Sites selected one of three models: one-way data transmission between two systems, bidirectional transmission between two systems, and integration into one data system. Focus group discussion themes included: challenges of using existing data systems; concerns about the burden of learning a new data system; and potential benefits to providers and client, such as having more time to spend delivering client services. Discussion Using health information technologies to share data has widespread support, but uptake is still met with resistance from end users. The additional level of complexity differentiating this study from others is the exchange of data between service providers and care providers, but sites were able to accomplish this goal by navigating extensive barriers.

scholarly journals Use of text messaging in general practice: a mixed methods investigation on GPs’ and patients’ views

2017 ◽  
Vol 67 (664) ◽  
pp. e744-e750 ◽  
Author(s):  
Dorothy Leahy ◽  
Aoife Lyons ◽  
Matthias Dahm ◽  
Diarmuid Quinlan ◽  
Colin Bradley
Keyword(s):  
General Practice ◽  
Mixed Methods ◽  
Focus Group ◽  
Time Management ◽  
Text Messaging ◽  
Text Messages ◽  
Telephone Surveys ◽  
It Systems ◽  
Address Data ◽  
Five Practices

BackgroundText messaging has become more prevalent in general practice as a tool with which to communicate with patients.AimThe main objectives were to assess the extent, growth, and perceived risks and benefits of text messaging by GPs to communicate with patients, and assess patients’ attitudes towards receiving text messages from their GP.Design and settingA mixed methods study, using surveys, a review, and a focus group, was conducted in both urban and rural practices in the south-west of Ireland.MethodA telephone survey of 389 GPs was conducted to ascertain the prevalence of text messaging. Subsequently, the following were also carried out: additional telephone surveys with 25 GPs who use text messaging and 26 GPs who do not, a written satisfaction survey given to 78 patients, a review of the electronic information systems of five practices, and a focus group with six GPs to ascertain attitudes towards text messaging.ResultsIn total, 38% (n = 148) of the surveyed GPs used text messaging to communicate with patients and 62% (n = 241) did not. Time management was identified as the key advantage of text messaging among GPs who used it (80%; n = 20) and those who did not (50%; n = 13). Confidentiality was reported as the principal concern among both groups, at 32% (n = 8) and 69% (n = 18) respectively. Most patients (99%; n = 77) were happy to receive text messages from their GP. The GP focus group identified similar issues and benefits in terms of confidentiality and time management. Data were extracted from the IT systems of five consenting practices and the number of text messages sent during the period from January 2013 to March 2016 was generated. This increased by 40% per annum.ConclusionCollaborative efforts are required from relevant policymakers to address data protection and text messaging issues so that GPs can be provided with clear guidelines to protect patient confidentiality.

scholarly journals Yoga for Health-Related Quality of Life in Adult Cancer: A Randomized Controlled Feasibility Study

2015 ◽  
Vol 2015 ◽  
pp. 1-12 ◽  
Author(s):  
Marcy McCall ◽  
Melanie McDonald ◽  
Sally Thorne ◽  
Alison Ward ◽  
Carl Heneghan
Keyword(s):  
Mixed Methods ◽  
Large Scale ◽  
Online Survey ◽  
Controlled Trial ◽  
Feasibility Trial ◽  
Yoga Intervention ◽  
Randomized Controlled ◽  
Patient Reported ◽  
Related Quality ◽  
Implementation Costs

An increase in patient-led uptake of complementary therapies in adult cancer has led to a need for more rigorous study of such interventions and their outcomes. This study therefore aimed to evaluate the feasibility and acceptability of a yoga intervention in men and women receiving conventional treatment for a cancer diagnosis. Prospective, mixed methods feasibility trial allocated participants to receive one of three yoga interventions over a four-week study period. Data collection was completed through online survey of QOL-CA/CS and customized surveys. Fifteen participants were included (11 female) undergoing treatment for breast, prostate, colorectal, brain, and blood and lung cancer. Two participants dropped out and complete qualitative and quantitative data sets were collected from 12 participants and four yoga instructors. Other outcome measures included implementation costs patient-reported preferences for yoga intervention and changes in QOL-CA/CS. Three types of yoga intervention were safely administered in adult cancer. Mixed methods, cost-efficiency, QOL-CA/CS, and evidence-based design of yoga intervention have been used to establish feasibility and patient-preferences for yoga delivery in adult caner. Results suggest that, with some methodological improvements, a large-scale randomized controlled trial is warranted to test the efficacy of yoga for male and female cancer patients. This trial is registered with Clinicaltrials.govNCT02309112.

scholarly journals Patient-Reported Outcomes During Immunotherapy for Metastatic Melanoma: Mixed Methods Study of Patients’ and Clinicians’ Experiences (Preprint)

2019 ◽  
Author(s):  
Lærke K Tolstrup ◽  
Helle Pappot ◽  
Lars Bastholt ◽  
Ann-Dorthe Zwisler ◽  
Karin B Dieperink
Keyword(s):  
Mixed Methods ◽  
Side Effects ◽  
Focus Group ◽  
Patient Reported Outcomes ◽  
Focus Group Interview ◽  
Group Interview ◽  
Feedback Form ◽  
Patient Feedback ◽  
Patient Reported ◽  
Ehealth Intervention

BACKGROUND The benefits of electronic patient reported outcomes (PRO) questionnaires have been demonstrated in many settings, including in hospitals and patient homes. However, it remains to be investigated how melanoma patients and their treating clinicians experience the electronic self-reporting of side effects and the derived communication. OBJECTIVE The primary objective of this study was to examine patients’ and clinicians’ experiences with an eHealth intervention for weekly monitoring of side effects during treatment with immunotherapy. METHODS An eHealth intervention based on questions from the PRO-Common Terminology Criteria for Adverse Events (CTCAE) library was used and tested in a randomized clinical trial with patients receiving immunotherapy for malignant melanoma and clinicians at a university hospital in Denmark. On a weekly basis, patients reported their symptoms from home during the treatment via a provided tablet. The electronic patient reports were available to clinicians in the outpatient clinic. A mixed methods approach was applied to investigate the patients’ and clinicians’ experiences with the intervention. Data from patient experiences were collected in a short survey, the Patient Feedback Form. Moreover, a subset of the patients participating in the survey was interviewed about their experience. Furthermore, one focus group interview with clinicians was carried out to elucidate their views. RESULTS A total of 57 patients completed the Patient Feedback Form, and 14 patients were interviewed. The focus group interview included 5 clinicians. Overall, patients and clinicians were satisfied with the tool. They believed it enhanced patients’ awareness of side effects and increased their feeling of involvement. The patients reported that it was easy to fill out the questionnaire and that it made sense to do so. However, a minority of the patients expressed in the interviews that they did not believe that the health care professionals had seen their reports when they came to the clinic, and that the reporting did not lead to increased contact with the department. CONCLUSIONS Overall, satisfaction with the eHealth intervention was high among patients and their treating clinicians. The tool was easy to use and contributed to greater symptom awareness and patient involvement. Thus, in terms of patient and clinician satisfaction with the tool, it makes sense to continue using the tool beyond the project period. CLINICALTRIAL ClinicalTrials.gov NCT03073031; https://tinyurl.com/tjx3gtu

scholarly journals A Multi-disciplinary Mixed-Methods Study of Group Dynamics in Active Learning Space

2020 ◽  
Vol 20 (3) ◽  
Author(s):  
Xiaoshan Zhu Gordy ◽  
Elizabeth O. Carr ◽  
Lei Zhang ◽  
Jessica H. Bailey
Keyword(s):  
Mixed Methods ◽  
Active Learning ◽  
Focus Group ◽  
Student Learning ◽  
Group Dynamics ◽  
Peer Relations ◽  
Online Survey ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Learning Space

Active learning space emerged at the turn of the twenty-first century. The active learning space design represents not only an overhaul of traditional classrooms’ physical appearances but also reflects a paradigm shift from teacher-centered learning to student-centered learning. Current available research mainly focused on student academic performance as well as student and faculty perceptions.  No research has been conducted to investigate interactions at the student level to find out what interactions are taking place in the active learning space and how they affect student learning. This study employed a sequential exploratory mixed-methods design inquiring into student learning in an active learning space first through student focus group discussions and then with an online student survey. The major themes emerged from the focus group discussions were utilized to develop the online survey. The purpose of this survey was to cross-validate qualitative outcomes and further seek answers to unanswered questions triggered by qualitative findings. The qualitative data indicated that the spatial equity in the active learning space put students in positive mindsets and induced active classroom participation. The interconnected screens made it easy for students to view class content and collaborate with peers. The group work conducted in the space fostered mutual learning, promoted learning accountability and improved peer relations. The quantitative survey data on group dynamics validated and reinforced qualitative findings. This paper will help educators better understand student behaviors in the active learning space and better design space-appropriate pedagogical strategies.

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