scholarly journals Patient factors driving overuse of cardiac catheterisation: a qualitative study with 25 participants from two German teaching practices

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e024600 ◽  
Author(s):  
Anna Herwig ◽  
Dorothea Dehnen ◽  
Birgitta Weltermann
Keyword(s):  
Teaching Practices ◽  
Qualitative Content Analysis ◽  
Stable Coronary Artery Disease ◽  
Cardiac Catheterisation ◽  
Structured Interviews ◽  
Patient Factors ◽  
Qualitative Interview Study ◽  
Patient’S Experience ◽  
Artery Disease ◽  
Physician Adherence

ObjectivesPercutaneous coronary interventions do not provide a benefit over medical therapy for stable patients. However, an overuse of cardiac catheterisation (CC) for stable coronary artery disease (CAD) is documented in Germany and other countries. In this study, we aim to understand patient factors that foster this overuse.DesignOur study is an exploratory qualitative interview study with narrative, structured interviews. The interviews were analysed using qualitative content analysis by Mayring.SettingThe interviews were conducted in two German teaching practices.Participants24 interviews with 25 patients were conducted; 17 (68%) patients were male, the average age was 73.9 years (range 53–88 years). All patients suffered from CAD and had undergone at least one CC. Patients with known anxiety disorders were excluded from the study.ResultsThe analysis identified six patient factors which contributed to or prevented the overuse of CC: (1) unquestioned acceptance of prescheduled appointments for procedures/convenience; (2) disinterest in and/or lack of disease-specific knowledge; (3) helplessness in situations with varying opinions on the required care; (4) fear of another cardiac event, (5) patient–physician relationship and (6) the patient’s experience that repeat interventions did not result in a change of health status or care.ConclusionsConducted in a country with documented overuse of CC, we showed that most patients trusted their physicians’ recommendations for repeat coronary angiographies even if they were asymptomatic. Strategies to align physician adherence with guidelines and corresponding patient information are needed to prevent overuse.

scholarly journals Study protocol for a matter of heart: a qualitative study of patient factors driving overuse of cardiac catheterisation

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e017629 ◽  
Author(s):  
Anna Herwig ◽  
Birgitta Weltermann
Keyword(s):  
Qualitative Study ◽  
Information Needs ◽  
Qualitative Content Analysis ◽  
Cardiac Catheterisation ◽  
Diagnostic Approach ◽  
Patient Factors ◽  
Coronary Syndrome ◽  
Non Invasive ◽  
Qualitative Interview Study ◽  
Stable Cad

IntroductionOveruse of cardiac catheterisation (CC) for stable coronary artery disease (CAD) is documented in Germany and other regions, although percutaneous coronary interventions do not provide a benefit over medical therapy for stable patients. Various studies investigated health system, physician and patient factors driving non-adherence to guidelines which recommend a stepwise approach with invasive procedures only in case of signs of ischaemia in non-invasive testing. In a larger-scale project, we aim to better understand the patients’ perspective in order to develop an intervention that enhances patient’s acceptance of this stepwise diagnostic approach for stable CAD. As a first step, this qualitative study aims to identify patient factors that prevent and promote the described overuse.Methods and analysisThe exploratory qualitative interview study will include about 20 patients with stable CAD and a history of acute coronary syndrome from two German teaching practices. Narrative, structured interviews designed to last 30 to 90 min will be conducted. The interviews will be analysed using qualitative content analysis by Mayring. The analysis will address the following questions: (1) What are reasons for stable patients to undergo CC? (2) How do patients deal with their heart disease (secondary prevention)? (3) Which processes do patients describe regarding decision-making for non-invasive and invasive coronary procedures? (4) What information needs exist on behalf of patients to better understand the stepwise diagnostic approach outlined in guidelines and thereby avoid low-appropriate CCs? Based on these data, empirical typification will be conducted.Ethics and disseminationEthical approval for the study was obtained. All participants will provide written informed consent. Data will be pseudonymised for analysis. The findings will contribute to the development of an appropriate intervention. Results will be disseminated by conference presentations and journal publications.

scholarly journals “Hello, My Name Is Melinda” – Students' Views on a Digital Assistant for Navigation in Digital Learning Environments; A Qualitative Interview Study

2021 ◽  
Vol 5 ◽  
Author(s):  
Anne Herrmann-Werner ◽  
Teresa Loda ◽  
Florian Junne ◽  
Stephan Zipfel ◽  
Amir Madany Mamlouk
Keyword(s):  
Qualitative Content Analysis ◽  
Personal Digital Assistant ◽  
Digital Learning ◽  
Structured Interviews ◽  
Digital Learning Environment ◽  
Qualitative Research Design ◽  
Qualitative Interview Study ◽  
Students Attitudes ◽  
Negative Impacts ◽  
Related Stress

Background: The goal of the current investigation was to find out about students attitudes and needs toward the development of a new personal digital assistant (PDA) to help them navigate through an increasingly digital learning environment (DLE). As students have repeatedly been shown to be an especially stress-prone user-group, a PDA serving as a digital secretary might additionally significantly reduce study-related stress.Methods:N = 12 STEM (science, technology, engineering, and math) students in various years of study at the University of Luebeck, Germany, participated in the study. A qualitative research design of semi-structured interviews was used with the interviews evaluated according to Mayring's qualitative content analysis using MAXQDA Version 2018.Results: Students being educated in a DLE in many cases report positive as well as negative impacts on communication through progressing digitalisation. In line with previous findings, students indicated several study-related and personal stressors during their academic life, but they also reported a variety of preventive factors such as motivation and interest in their studies as well as social support. When asked specifically about desired functions of a future PDA, students wished for a kind of digital secretary with functions such as recording, calendarisation and automated exam registration.Conclusions: Valuable insights were obtained regarding all areas of interest – DLE, stressors and preventive factors of students being educated within DLE, and ideas regarding the development of a new, student-user-friendly PDA. Previous results from stress research in student samples combined with the insights from the present study support the thought that a PDA combining administrative and counseling functions might be a new idea for students and could potentially complement a simple administrative PDA, additionally helping to provide students with therapeutic or counseling needs.

scholarly journals The psychological burden of volunteers in psychosocial emergency care – a qualitative interview study

2021 ◽  
Author(s):  
Anja Greinacher ◽  
Anna Cranz ◽  
Julia Jenzer ◽  
Alexander Nikendei ◽  
Renate Kottke ◽  
...  
Keyword(s):  
Emergency Care ◽  
Qualitative Content Analysis ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Psychological Burden ◽  
Work Related ◽  
Qualitative Interview Study ◽  
Depth Analysis ◽  
Psychosocial Emergency ◽  
Emergency Responses

AbstractPsychosocial emergency care personnel provide voluntary psychological support directly after potentially traumatic events. During emergency responses, they experience challenging situations. However, previous quantitative studies suggest that the psychological burden of psychosocial emergency care personnel does not exceed that of the general population. This study aimed to obtain an in-depth analysis of the volunteers’ psychological reactions and resources regarding emergency responses. 36 psychosocial emergency care volunteers (12 pre-training, 12 post-training, 12 experienced) were invited to participate in semi-structured interviews. The volunteers were selected from previous cross-sectional and longitudinal studies on secondary traumatization in psychosocial emergency care volunteers. A qualitative content analysis of the transcribed interviews was performed following the principles of summary and inductive category development. We identified 845 codes which we summarized in three overarching categories: (I) reactions to emergency responses, (II) psychosocial emergency care work related resources and (III) experiences and changes in life perspective related to working in psychosocial emergency care. The volunteers described both emotional and physical reactions to emergency responses. While they perceived social support as a key coping resource and reported a greater appreciation of their own lives and their families due to their work, many volunteers also felt increased concern that something could happen to them. The volunteers’ reactions and symptoms are reasonable responses to stress and not indicative of serious impairment. Nevertheless, emergency responses are both emotionally and physically challenging. Volunteers should be carefully selected, receive regular supervision and determine the frequency of emergency responses.

scholarly journals Health care professionals’ experiences of how an eHealth application can function as a value-creating resource - a qualitative interview study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Catharina Carlqvist ◽  
Heidi Hagerman ◽  
Markus Fellesson ◽  
Mirjam Ekstedt ◽  
Amanda Hellström
Keyword(s):  
Health Care ◽  
Value Creation ◽  
Health Care Professionals ◽  
Qualitative Content Analysis ◽  
Active Role ◽  
Formation Processes ◽  
Structured Interviews ◽  
A Value ◽  
Number Of Patients ◽  
Qualitative Interview Study

Abstract Background The number of patients with one or more chronic conditions is increasing globally. One strategy to achieve more sustainable care for these patients is by implementing use of home-based eHealth applications. Such services support patients to take on a more active role as value-creating co-producers of their own care, in collaboration with health care professionals. Health care professionals have a key role in the value creation process, but little is known about value formation within eHealth interactions, especially from their perspective. Therefore, this study aimed to provide a deeper understanding of how an eHealth application can function as a value-creating resource from the perspective of health care professionals. Methods Semi-structured interviews were conducted with thirteen health care professionals (nurses, physicians and first-line managers). Qualitative content analysis was used to analyze the interviews. Results The findings indicate that value formation processes are strongly influenced by the organizational preconditions and by the usability and functionality of technology. The experiences of the health care professionals indicated that value was conceptualized in dimensions of meaningfulness, building of relationships, building safety and feelings of trust. Although these dimensions were mainly expressed in a positive way, such as perceived improvement of medical care, accessibility and continuity, they also had a negative side that caused value destruction. This was primarily due to patient difficulties in using the application or making measurements. Subsequent efforts at value recovery resulted in value creation, but were often time-consuming for the professionals. Conclusions This study contributes by extending conceptualizations of value to the role of health care professionals and by highlighting technology as sometimes facilitating and sometimes hampering value formation processes. The findings indicate that the eHealth application was a value-creating resource, facilitating proactive communication and supporting patients’ engagement and control over their self-care. However, for the application to become a more valuable resource in practice and counteract inequity in care, it needs to be further developed to be adapted to the needs and preconditions of patients.

scholarly journals Digitalising a Brief Intervention to Reduce Intrusive Memories of Psychological Trauma: Qualitative Interview Study (Preprint)

2020 ◽  
Author(s):  
Beau Gamble ◽  
Katherine Depa ◽  
Emily A Holmes ◽  
Marie Kanstrup
Keyword(s):  
Clinical Symptom ◽  
Brief Intervention ◽  
Qualitative Content Analysis ◽  
Computer Game ◽  
Psychological Trauma ◽  
Structured Interviews ◽  
Pilot Testing ◽  
Intrusive Memories ◽  
Face To Face ◽  
Qualitative Interview Study

BACKGROUND The COVID-19 pandemic has escalated the global need for remotely-delivered and scalable interventions after psychological trauma. A brief intervention involving a computer game as an imagery-competing task has shown promising results for reducing the number of intrusive memories of trauma—a core clinical symptom of posttraumatic stress disorder. To date, the intervention has only been delivered face-to-face. To be tested and implemented on a wider scale, digital adaptation for remote delivery is crucial. An important first step is to develop digitalised intervention materials in a systematic way based on feedback from clinicians, researchers and students, in preparation for pilot-testing with target-users. OBJECTIVE Our first aim was to obtain and analyse qualitative feedback on the digital intervention materials, namely two animated videos and two quizzes that (i) explain the target clinical symptom, and (ii) provide intervention instructions. The second aim was to refine the digitalised materials based on this feedback. METHODS We carried out semi-structured interviews with 12 participants who had experience delivering or had knowledge of the intervention when delivered face-to-face. We obtained in-depth feedback on perceived feasibility of using the digitalised materials and suggestions for improvements. Interviews were assessed using qualitative content analysis, and suggested improvements evaluated for implementation using a systematic method of prioritisation. RESULTS Three overarching themes were identified from the data. First, participants were highly positive about the potential benefits of using these digital materials for remote delivery, reporting that the videos effectively conveyed key concepts of the symptom and its treatment. Second, some modifications to the materials were suggested for improving clarity; based on this feedback we made nine specific changes. Finally, participants raised some key challenges for remote delivery, mainly in overcoming the lack of real-time communication during the intervention. CONCLUSIONS Clinicians, researchers and clinical psychology students were overall confident in the use of digitalised materials to remotely deliver a brief intervention to reduce intrusive memories of trauma. Guided by participant feedback, we identified and implemented changes to refine the intervention materials. This study lays the groundwork for the next step: pilot-testing remote delivery of the full intervention to trauma survivors.

Challenges faced by peer support workers during the integration into hospital-based mental health-care teams: Results from a qualitative interview study

2020 ◽  
Vol 66 (3) ◽  
pp. 263-269
Author(s):  
Ina Otte ◽  
Anna Werning ◽  
Alexa Nossek ◽  
Jochen Vollmann ◽  
Georg Juckel ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Peer Support ◽  
Qualitative Content Analysis ◽  
Psychiatric Hospitals ◽  
Health Care Teams ◽  
Structured Interviews ◽  
Qualitative Interview Study ◽  
Specific Implementation

Background: Being aware of the challenges that may occur during the implementation of peer support work in psychiatry is important to facilitate the integration of peer support workers (PSWs) into multidisciplinary mental health-care teams. Aim: The purpose of this study is to explore the challenges faced by PSWs during their integration into hospital-based mental health-care teams. Methods: Qualitative content analysis of nine open-ended, semi-structured interviews with PSWs is undertaken in five adult psychiatric hospitals in North Rhine-Westphalia, Germany. Results: The analysis of the data revealed three themes: (1) ‘Pioneers and the pressure to succeed’; (2) ‘a colleague, a rival or yet another patient?’ and (3) ‘sharing of information, boundaries and professionalism’. All three themes relate to several concrete challenges on different systemic levels and have the potential to impede the PSWs’ integration process. Conclusion: Specific implementation strategies which address potential barriers on the different systemic levels should be developed and applied prior to the start of the integration of PSWs into multidisciplinary mental health-care teams.

scholarly journals Evaluation of the Implementation of a 25-Year Outdoor School Ground Smoking Ban: A Qualitative Interview Study With Implications for Prevention Practise

2021 ◽  
Vol 9 ◽  
Author(s):  
Pia Kvillemo ◽  
Kristin Feltmann ◽  
Tobias H. Elgán ◽  
Johanna Gripenberg
Keyword(s):  
Secondary Schools ◽  
Qualitative Content Analysis ◽  
Working Hours ◽  
Smoking Ban ◽  
Structured Interviews ◽  
Qualitative Interview Study ◽  
Upper Secondary ◽  
Local Politicians ◽  
Upper Secondary Schools ◽  
School Ground

Introduction: Tobacco use, often initiated in younger ages, is a serious health challenge worldwide. In Sweden, smoking has been prohibited on school grounds since 1994. Municipal environmental and health inspectors control the compliance of the ban. Nevertheless, the enforcement and maintenance of the ban are inadequate. The aim of the current study was to identify facilitators, barriers, and the potential for improved implementation of a 25-year outdoor school ground smoking ban in upper secondary schools.Materials and Methods: A process evaluation was conducted using semi-structured interviews with principals in upper secondary schools, local environmental and health inspectors, and local politicians (n = 30) in Stockholm County, with purposive sampling for informant recruitment. A qualitative content analysis of the transcribed interviews was performed.Results: Three main categories and 10 subcategories were generated from the interviews, revealing facilitators, barriers, and the potential for improvement of the implementation of the ban. A prominent facilitator of the ban was informed and engaged principals and inspectors. Prominent barriers were conflicting goals governing the schools, which reduce staffs' motivation to maintain the ban, unclear school ground boundaries, and lack of resources. Potential for improvement was found in a new tobacco act with an extended ban on smoking at school entrances, extended support for schools and staff to strictly enforce the ban, and a continued denormalisation of smoking in society.Conclusion: To achieve effective implementation of outdoor school ground smoking bans in upper secondary schools, authorities need to address conflicts between different goals governing the schools and give necessary support to the staff to strictly enforce the ban. Policies on smoke-free working hours in the municipalities along with tobacco restrictive policies in the surrounding society may increase the possibility to maintain the smoking ban in upper secondary school grounds.

scholarly journals Multivariable Analysis of Primary Care Physician Adherence to Guideline-recommended Pharmacotherapy of Stable Coronary Artery Disease

2020 ◽  
pp. 27-33
Author(s):  
S. K. Zyryanov ◽  
S. B. Fitilev ◽  
A. V. Vozzhaev ◽  
I. I. Shkrebniova
Keyword(s):  
Myocardial Infarction ◽  
Primary Care ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Arterial Hypertension ◽  
Stable Coronary Artery Disease ◽  
Care Physician ◽  
Related Factors ◽  
Artery Disease ◽  
Physician Adherence

Aim. To study predictors of primary care physician adherence to guideline-recommended pharmacotherapy of stable coronary artery disease.Material and methods. This pharmacoepidemiologic cross-sectional study was conducted in primary care setting of Moscow. 805 patients (mean age 68.9±9.9 years, males 51.4%) with established stable coronary artery disease (SCAD) were included. Demography, medical history, prescribed pharmacological treatment data were obtained. Physician adherence to guideline-recommended pharmacotherapy (GRP) of SCAD was evaluated based on the Class I guideline recommendations. Pharmacotherapeutic guideline adherence index (PGAI) was introduced as composite quality indicator, calculated in line with “all-or-none” rule and in regard with documented contraindications. To search for predictors of adherence the patient population was divided in two groups by level of physician adherence measured by PGAI. Statistical analysis was performed by IBM SPSS Statistics 16.0, the level of statistical significance was set at p<0.05.Results. The prescription rates of essential drug therapies of SCAD (regarding contraindications) were quite adequate: beta-blockers/calcium channel blockers – 90,1%, acetylsalicylic acid/clopidogrel/oral anticoagulants – 95,7%, statins/ezetimibe – 86,3%, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers – 87,6%. 82,9% (n=667) of patients were prescribed treatment for SCAD in compliance with the guidelines. Suboptimal pharmacotherapy was identified in 17,1% (n=138) of patients. These groups were similar in sex distribution (males 50,4 vs. 56,5%; p=0,188). Mean age tended to be lower in GRP adherent group (68,5±9,9 vs. 70,6±10,0 years; p=0,052). Bivariable analysis showed that good adherence to guideline-recommended pharmacotherapy was associated with higher prevalence of stable angina (66,4 vs. 53,6%; p=0,004), arterial hypertension (93,3 vs. 79,7%; p<0,001) and dyslipidemia (21,4 vs. 9,4%; p<0,001) and with lower prevalence of myocardial infarction (48,1 vs. 67,4%; p<0,001). Logistic multivariable regression model (gender, age, 6 medical history variables) identified 6 patient-related factors that were significantly associated with physician adherence to guideline-recommended pharmacotherapy: age (odds ratio [OR] 0,97; 95% confidence interval [CI] 0,95-0,99; p=0,009), arterial hypertension (OR 3,89; 95%CI 2,19-6,90; p<0,001), dyslipidemia (OR 2,31; 95%CI 1,23-4,34; p=0,009), chronic heart failure (OR 1,95; 95%CI 1,06-3,61; p=0,032), revascularization (OR 2,14; 95%CI 1,33-3,45; p=0,002), myocardial infarction (OR 0,28; 95%CI 0,16-0,48; p<0,001).Conclusion. Primary care cardiologist adherence to guideline-recommended pharmacotherapy of SCAD was satisfactory evaluated as 82,9% by composite indicator PGAI. Arterial hypertension, heart failure, dyslipidemia и revascularization were predictors of better physician adherence. History of myocardial infarction and older age were risk factors of non-adherence. Identification of patient-related factors associated with underperformance may facilitate tailoring quality improvement interventions in primary care of coronary patients.

scholarly journals Mutual trust is a prerequisite for nurses’ sense of safety and work satisfaction – Mobile Integrated Care Model: A qualitative interview study

2021 ◽  
pp. 205715852110621
Author(s):  
Lina Hovlin ◽  
Catharina Gillsjö ◽  
Anna K. Dahl Aslan ◽  
Jenny Hallgren
Keyword(s):  
Health Care ◽  
Integrated Care ◽  
Home Health Care ◽  
Older Persons ◽  
Qualitative Content Analysis ◽  
Work Satisfaction ◽  
Care Model ◽  
Structured Interviews ◽  
Care Needs ◽  
Qualitative Interview Study

An increasing number of older persons have complex health care needs. This, along with the organizational principle of remaining at home, emphasizes the need to develop collaborations among organizations caring for older persons. A health care model developed in Sweden, the Mobile Integrated Care Model aims to promote work in teams across organizations. The aim of the study was to describe nurses’ experiences in working and providing health care in the Mobile Integrated Care Model in the home with home health care physicians. Semi-structured interviews were conducted with 18 nurses and analyzed through qualitative content analysis. The method was compliant with the COREQ checklist. A mutually trusting collaboration with physicians, which formed person-centered care, created work satisfaction for the nurses. Working within the Mobile Integrated Care Model was negatively impacted by being employed by different organizations, lack of time to provide health care, and physicians’ person-centered work abilities.

scholarly journals Implementation of the concept of standard operating procedures into primary care practice: utopia or urgent need?

2020 ◽  
pp. 75-84
Author(s):  
S K. Zyryanov ◽  
S B. Fitilev ◽  
A. V. Vozzhaev ◽  
I. I. Shkrebniova ◽  
A. A. Tyazhelnikov ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Primary Care Practice ◽  
Quality Management System ◽  
Stable Coronary Artery Disease ◽  
Standard Operating Procedures ◽  
Care Practice ◽  
Standard Operating ◽  
Artery Disease ◽  
Physician Adherence

The article emphasizes the need to develop and apply standard operating procedures (SOP) as an instrument of quality management system of rational pharmacotherapy in primary care practice. To justify the reasonability of SOP implementation into outpatient clinical practice pharmacoepidemiologic analysis of the quality of care provided to patients with stable coronary artery disease in the primary care setting of Moscow over two consecutive periods was used. tte key variables of interest were characteristics that reflected physician adherence to clinical practice guidelines.

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