Can Treatment Adherence Be Improved by Using Rubin's Four Tendencies Framework to Understand a Patient's Response to Expectations

Jeremy Kirk; Anita MacDonald; Paul Lavender; Jessica Dean; Gretchen Rubin

doi:10.1159/000484261

Can Treatment Adherence Be Improved by Using Rubin's Four Tendencies Framework to Understand a Patient's Response to Expectations

Biomedicine Hub ◽

10.1159/000480347 ◽

2017 ◽

Vol 2 (2) ◽

pp. 1-12

Author(s):

Jeremy Kirk ◽

Anita MacDonald ◽

Paul Lavender ◽

Jessica Dean ◽

Gretchen Rubin

Keyword(s):

Treatment Adherence ◽

Patient Outcomes ◽

Healthcare Costs ◽

Healthcare Professionals ◽

Treatment Plan ◽

Patient Specific ◽

Call To Action ◽

Specific Strategy ◽

Key Factor ◽

Plan Movement

Within the context of poorer patient outcomes and rising healthcare costs, we need to better understand why many patients do not engage fully with their treatment plan. Movement away from talking about “compliance” towards “adherence” and “concordance” is evidence of a recognition that this is a two-way process. Whilst healthcare professionals expect patients to engage in treatment, equally, patients have expectations (whether positive or negative) of their treatment and their need for engagement. There is a need for an effective method that can specifically target those interventions that will provide the most benefit to individual patients and which, crucially, is easy and inexpensive to administer in everyday practice and widely applicable. Rubin's Four Tendencies model identifies a patient's “response to outer and inner expectations” as a key factor in adherence. The model therefore provides an opportunity to test such a targeted, patient-specific strategy and we present a call to action for research in this area.

Evaluation and Management of Shock States

Journal of Pharmacy Practice ◽

10.1177/0897190010388150 ◽

2010 ◽

Vol 24 (1) ◽

pp. 44-60 ◽

Cited By ~ 18

Author(s):

Michael P. Moranville ◽

Katherine D. Mieure ◽

Elena M. Santayana

Keyword(s):

Patient Outcomes ◽

Treatment Plan ◽

Hypovolemic Shock ◽

Clinical Signs ◽

Specific Treatment ◽

Signs And Symptoms ◽

Therapeutic Interventions ◽

Initial Assessment ◽

Patient Specific ◽

Therapeutic Goals

Shock states have multiple etiologies, but all result in hypoperfusion to vital organs, which can lead to organ failure and death if not quickly and appropriately managed. Pharmacists should be familiar with cardiogenic, distributive, and hypovolemic shock and should be involved in providing safe and effective medical therapies. An accurate diagnosis is necessary to initiate appropriate lifesaving interventions and target therapeutic goals specific to the type of shock. Clinical signs and symptoms, as well as hemodynamic data, help with initial assessment and continued monitoring to provide adequate support for the patient. It is necessary to understand these hemodynamic parameters, medication mechanisms of action, and available mechanical support when developing a patient-specific treatment plan. Rapid therapeutic intervention has been proven to decrease morbidity and mortality and is crucial to providing the best patient outcomes. Pharmacists can provide their expertise in medication selection, titration, monitoring, and dose adjustment in these critically ill patients. This review will focus on parameters used to assess hemodynamic status, the major causes of shock, pathophysiologic factors that cause shock, and therapeutic interventions that should be employed to improve patient outcomes.

Impact of the Dial Access Drug Information Service on Patient Outcome

Annals of Pharmacotherapy ◽

10.1345/aph.19173 ◽

2000 ◽

Vol 34 (5) ◽

pp. 585-592 ◽

Cited By ~ 38

Author(s):

Paul S Melnyk ◽

Yvonne M Shevchuk ◽

Alfred J Remillard

Keyword(s):

Patient Outcome ◽

Patient Outcomes ◽

Healthcare Professionals ◽

Drug Information ◽

Information Service ◽

Positive Patient ◽

Patient Specific ◽

Subjective Data ◽

Drug Information Service ◽

The Impact

OBJECTIVE: To determine the impact of a drug information service on patient outcomes. DESIGN: Prospective evaluation of patient-specific drug information requests. SETTING: Healthcare professional and consumer drug information service located at a college of pharmacy. PARTICIPANTS: Consumers and healthcare professionals of the province. INTERVENTION: Patient-specific questions received by the drug information service were reviewed and evaluated for actual patient outcome, inquirers' opinion of impact of the service with respect to patient outcome, and for objectivity and timeliness of the response. An expert panel determined whether the responses and recommendations given by the service were appropriate, determined what impact the service had on the patient, and assessed the seriousness of the inquiry. MAIN OUTCOME MEASURE: Classification of patient outcome by objective and subjective data based on predetermined desired outcomes. RESULTS: Ninety-eight and 68 patient-specific requests were received from healthcare professionals and consumers, respectively. The panel concluded that 94.9% of the healthcare requests and 98.5% of the consumer requests were answered appropriately and that the majority of the requests involved potentially serious drug-related problems. The panel also determined that 46.8% of the recommendations to healthcare professionals and 41.0% of the recommendations to consumers resulted in positive patient outcomes. The majority of the positive outcomes involved the prevention of a disease or its symptoms (professional section) and the reduction or elimination of symptoms (consumer section). CONCLUSIONS: The drug information service not only met its objectives of providing drug information in an accurate, objective, and timely manner, but was also able to provide positive patient outcomes.

Full Mouth Fixed Rehabilitation of a Young Adult with Ectodermal Dysplasia: Making Mountain Out of a Molehill in The Literal Sense

Journal of Dentistry and Oral Sciences ◽

10.37191/mapsci-2582-3736-2(2)-030 ◽

2020 ◽

Author(s):

Vaishnavi Rajaraman

Keyword(s):

Ectodermal Dysplasia ◽

Treatment Plan ◽

Sweat Glands ◽

Congenital Diseases ◽

Facial Esthetics ◽

Key Factor ◽

Full Mouth Rehabilitation ◽

Fixed Prosthesis ◽

Multiple Abnormalities ◽

Hereditary Condition

The personality of an individual is often judged by his looks. A beautiful smile brings immense pleasure, not only to the viewer but also to the wearer of the smile. Time and again in dentistry, esthetics has been the prime area of focus. Prosthodontic rehabilitation also involves esthetics as its key factor, which is challenging especially in patients with congenital diseases or syndromes. Ectodermal dysplasia is one such hereditary condition associated with failure of the development of ectoderm in the embryonic stage and can cause multiple abnormalities. The ectodermal structures like skin, nails, hair, sweat glands, and teeth are particularly affected. The management of ectodermal dysplasia is quite complex and multidisciplinary owing to the abnormal morphology in craniofacial structures, a wide array of dentofacial defects, and age of the affected individuals, as most of them are very young when they report for or are evaluated for treatment. The deciduous as well as the permanent dentition in these patients may present with anodontia, hypodontia or oligodontia or combination of these. Hypodontia is one of the most common intraoral finding among these scenarios. Therefore, the affected patients obviously require absolute attention towards prosthodontic treatments throughout their developmental years till their adulthood. This report presents a case of an adult diagnosed with having ectodermal dysplasia with hypodontia. By appropriate modification and customization, the prosthodontic management was meticulously planned for the young patient which involved a full mouth rehabilitation with tooth supported fixed prosthesis in the maxillary and mandibular arch. The devised treatment plan had a key impact on the psychological, the masticatory function, speech and facial esthetics of the patient.

Development of an intervention to increase adherence to nebuliser treatment in adults with cystic fibrosis: CFHealthHub

Pilot and Feasibility Studies ◽

10.1186/s40814-020-00739-2 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

M. A. Arden ◽

M. Hutchings ◽

P. Whelan ◽

S. J. Drabble ◽

D. Beever ◽

...

Keyword(s):

Cystic Fibrosis ◽

Development Strategy ◽

Treatment Adherence ◽

Behaviour Change ◽

Multidisciplinary Team ◽

Treatment Plan ◽

Controlled Trial ◽

Intervention Development ◽

Evidence Base ◽

Behaviour Change Techniques

Abstract Background Cystic fibrosis (CF) is a life-limiting genetic condition in which daily therapies to maintain lung health are critical, yet treatment adherence is low. Previous interventions to increase adherence have been largely unsuccessful and this is likely due to a lack of focus on behavioural evidence and theory alongside input from people with CF. This intervention is based on a digital platform that collects and displays objective nebuliser adherence data. The purpose of this paper is to identify the specific components of an intervention to increase and maintain adherence to nebuliser treatments in adults with CF with a focus on reducing effort and treatment burden. Methods Intervention development was informed by the Behaviour Change Wheel (BCW) and person-based approach (PBA). A multidisciplinary team conducted qualitative research to inform a needs analysis, selected, and refined intervention components and methods of delivery, mapped adherence-related barriers and facilitators, associated intervention functions and behaviour change techniques, and utilised iterative feedback to develop and refine content and processes. Results Results indicated that people with CF need to understand their treatment, be able to monitor adherence, have treatment goals and feedback and confidence in their ability to adhere, have a treatment plan to develop habits for treatment, and be able to solve problems around treatment adherence. Behaviour change techniques were selected to address each of these needs and were incorporated into the digital intervention developed iteratively, alongside a manual and training for health professionals. Feedback from people with CF and clinicians helped to refine the intervention which could be tailored to individual patient needs. Conclusions The intervention development process is underpinned by a strong theoretical framework and evidence base and was developed by a multidisciplinary team with a range of skills and expertise integrated with substantial input from patients and clinicians. This multifaceted development strategy has ensured that the intervention is usable and acceptable to people with CF and clinicians, providing the best chance of success in supporting people with CF with different needs to increase and maintain their adherence. The intervention is being tested in a randomised controlled trial across 19 UK sites.

Communication between healthcare professionals and parents is a key factor in involving parents in neonatal intensive care

Acta Paediatrica ◽

10.1111/apa.14111 ◽

2017 ◽

Vol 107 (1) ◽

pp. 12-13 ◽

Cited By ~ 1

Author(s):

Sari Ahlqvist-Björkroth

Keyword(s):

Intensive Care ◽

Neonatal Intensive Care ◽

Healthcare Professionals ◽

Key Factor

Remote Follow-up of Self-isolating COVID-19 Patients with a Patient Portal: Protocol for a Mixed-method Pilot Study (The Opal-COVID Study) (Preprint)

10.2196/preprints.35760 ◽

2021 ◽

Author(s):

David Lessard ◽

Kim Engler ◽

Yuanchao Ma ◽

Adriana Rodriguez Cruz ◽

Serge Vicente ◽

...

Keyword(s):

Patient Outcomes ◽

Mixed Method ◽

Healthcare Professionals ◽

Qualitative Interviews ◽

Sociodemographic Characteristics ◽

Patient Portal ◽

Implementation Outcomes ◽

Service Outcomes ◽

Qualitative Analyses

BACKGROUND Individuals diagnosed with COVID-19 are instructed to self-isolate at home. However, during self-isolation, they may experience anxiety and insufficient care. Some patient portals can allow patients to self-monitor and share their health status with healthcare professionals for remote follow-up, but little data is available on the feasibility of their use. OBJECTIVE This manuscript presents the protocol of the Opal-COVID Study which has four objectives: 1) assess the implementation of using the Opal patient portal for distance monitoring of COVID-19 patients self-isolating at home; 2) identify influences on the intervention’s implementation; and describe 3) service and 4) patient outcomes of this intervention. METHODS This mixed-method pilot study aims to recruit 50 COVID-19 patient participants tested at the McGill University Health Centre (MUHC, Montreal, Canada) for 14 days of remote follow-up. With access to questionnaires through the Opal patient portal smartphone app, configured for this study, patients will complete a daily self-assessment of symptoms, vital signs, and mental health, monitored by a nurse, and receive subsequent teleconsultations, as needed. Study questionnaires will be administered to collect data on sociodemographic characteristics, medical background, implementation outcomes (acceptability, usability, and respondent burden) and patient satisfaction. Coordinator logbook entries will inform on feasibility outcomes, namely, recruitment/retention rates and fidelity, as well as on the frequency and nature of contacts with healthcare professionals via Opal. The statistical analyses for Objectives 1 (implementation outcomes), 3 (service outcomes), and 4 (patient outcomes) will evaluate the effects of time and sociodemographic characteristics on the outcomes. For Objectives 1 (implementation outcomes) and 4 (patient outcomes), the statistical analyses will also examine the attainment of predefined success thresholds. As to the qualitative analyses, for Objective 2 (influences on implementation), semi-structured qualitative interviews will be conducted with four groups of stakeholders (i.e., patient participants, healthcare professionals, technology developers and study administrators) and submitted to content analysis, guided by the Consolidated Framework for Implementation Research to help identify barriers and facilitators of implementation. For Objective 3 (service outcomes), reasons for contacting healthcare professionals through Opal will also be submitted to content analysis. RESULTS Between December 2020 and March 2021, 51 patient-participants were recruited. Qualitative interviews were conducted with 39 involved stakeholders, from April to September 2021. Delays in the study process were experienced due to implemented measures at the MUHC to address COVID-19 but the quantitative and qualitative analyses are currently underway. CONCLUSIONS This protocol is designed to generate multidisciplinary knowledge on the implementation of a patient portal-based COVID-19 care intervention and will lead to a comprehensive understanding of feasibility, stakeholder experience, and influences on implementation that may prove useful for scaling up similar interventions. CLINICALTRIAL ClinicalTrials.gov identifier NCT04978233.

Conceptualizing Narrative Health and Medicine to Develop Cultural Competence to Improve Communication During the COVID-19 Pandemic

Advances in Social Sciences Research Journal ◽

10.14738/assrj.81.9577 ◽

2021 ◽

Vol 8 (1) ◽

pp. 32-36

Author(s):

Kent Willis ◽

Colleen Marzilli

Keyword(s):

Healthcare Professional ◽

Cultural Competence ◽

Severe Acute Respiratory Syndrome ◽

Patient Care ◽

Patient Outcomes ◽

Healthcare Professionals ◽

Important Concept ◽

Healthcare Environment ◽

Health Narrative ◽

Improve Patient

Narrative health is a technique that healthcare professionals can use to connect with patients. The events of 2020, including the global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have identified that patient care is largely dependent upon relationships within the healthcare environment. Relationships in the healthcare environment are established through a trusting exchange between the patient and provider, and one technique to develop this relationship and trust is through narrative health. Narrative health provides the exchange of information between patient and provider in a discussion-like manner, or narrative health. This strategy promotes cultural competence amongst the healthcare professional team and improves communication between the patient and provider. Narrative health is an important concept for healthcare professionals to understand, and narrative health should be a part of any healthcare professional’s toolbox, especially in vulnerable times like the COVID pandemic. The inclusion of narrative health in practice has the potential to improve patient outcomes and empower healthcare professionals and patients.

A Three-Dimensional-Printed Patient-Specific Phantom for External Beam Radiation Therapy of Prostate Cancer

Journal of Engineering and Science in Medical Diagnostics and Therapy ◽

10.1115/1.4040817 ◽

2018 ◽

Vol 1 (4) ◽

Cited By ~ 1

Author(s):

Christopher L. Lee ◽

Max C. Dietrich ◽

Uma G. Desai ◽

Ankur Das ◽

Suhong Yu ◽

...

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Treatment Plan ◽

Ejaculatory Duct ◽

Three Dimensional ◽

External Beam Radiation Therapy ◽

External Beam Radiation ◽

Patient Specific ◽

External Beam ◽

Beam Radiation

This paper presents the design evolution, fabrication, and testing of a novel patient and organ-specific, three-dimensional (3D)-printed phantom for external beam radiation therapy (EBRT) of prostate cancer. In contrast to those found in current practice, this phantom can be used to plan and validate treatment tailored to an individual patient. It contains a model of the prostate gland with a dominant intraprostatic lesion (DIL), seminal vesicles, urethra, ejaculatory duct, neurovascular bundles, rectal wall, and penile bulb generated from a series of combined T2-weighted/dynamic contrast-enhanced magnetic resonance (MR) images. The iterative process for designing the phantom based on user interaction and evaluation is described. Using the CyberKnife System at Boston Medical Center, a treatment plan was successfully created and delivered. Dosage delivery results were validated through gamma index calculations based on radiochromic film measurements which yielded a 99.8% passing rate. This phantom is a demonstration of a methodology for incorporating high-contrast MR imaging into computed-tomography-based radiotherapy treatment planning; moreover, it can be used to perform quality assurance (QA).

Lower extremity osteoarthritis: optimising musculoskeletal health is a growing global concern: a narrative review

British Journal of Sports Medicine ◽

10.1136/bjsports-2017-098051 ◽

2018 ◽

Vol 53 (13) ◽

pp. 806-811 ◽

Cited By ~ 4

Author(s):

Richard D Leech ◽

Jillian Eyles ◽

Mark E Batt ◽

David J Hunter

Keyword(s):

Patient Outcomes ◽

Key Management ◽

Structural Changes ◽

Healthcare Professionals ◽

Disease Process ◽

Evidence Based ◽

Musculoskeletal Health ◽

Proactive Approach ◽

Global Concern ◽

Improve Patient

The burden of non-communicable diseases, such as osteoarthritis (OA), continues to increase for individuals and society. Regrettably, in many instances, healthcare professionals fail to manage OA optimally. There is growing disparity between the strength of evidence supporting interventions for OA and the frequency of their use in practice. Physical activity and exercise, weight management and education are key management components supported by evidence yet lack appropriate implementation. Furthermore, a recognition that treatment earlier in the disease process may halt progression or reverse structural changes has not been translated into clinical practice. We have largely failed to put pathways and procedures in place that promote a proactive approach to facilitate better outcomes in OA. This paper aims to highlight areas of evidence-based practical management that could improve patient outcomes if used more effectively.