scholarly journals The Effect of "Pathway" to Diagnosis for Childhood ITP on Caregiver Quality of Life at Time of Diagnosis

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 2174-2174
Author(s):  
Michelle Neier ◽  
Michele P. Lambert ◽  
Rachael F. Grace ◽  
Kerry Hege ◽  
Stephanie Chiu ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Research Funding ◽  
Care Providers ◽  
Significant Difference ◽  
Time To Diagnosis ◽  
The Impact

Background: Immune thrombocytopenia (ITP) is an immune mediated bleeding disorder characterized by isolated thrombocytopenia. ITP can have a variety of presentations from asymptomatic to life threatening bleeding. Although childhood ITP is most often a self-resolving illness which can be closely observed without intervention, it can be associated with significant impact on quality of life (QoL). Prospective studies of QoL in ITP patients show that there is not always a correlation with treatment or disease severity. The pathway from initial presentation to final diagnosis varies and may include encounters with emergency room, primary care or specialty providers. There have been no published studies to date showing the impact of factors prior to the diagnosis of ITP on treatment decision making and QoL. Objective: To identify the role of physician-patient and physician-caregiver interactions on the QoL and emotional well-being of patients and their families. Ascertaining the impact of pre-diagnosis factors may provide an opportunity to improve access and quality of care provided. Methods: The ITP Consortium of North America (ICON) "Pathways" study was a multicenter observational prospective cohort study focused on the pathways to diagnosis of ITP. The study was supported by a Foundation for Morristown Medical Center Research Fund Grant. Subjects were included if they had presumed primary ITP and were age >12 months to <18 years. Subjects were excluded if they had secondary ITP, including Evans syndrome. Treatment was determined by the physician. Subjects were consented and presented with questionnaires to be completed at the conclusion of the initial hematology visit. The hematologist also completed survey data at that time. Survey data forms included demographic form, physician form, Peds QL Family Impact Questionnaire, Kids ITP tools (KIT) Parent Impact Report and parent proxy report, and child (patient) KIT self-report. There was a parent questionnaire which included a question about worry with a scale from 0 to 10. Study data were collected and managed using REDCap electronic data capture tools hosted at Atlantic Health System. Correlation between variables were calculated using Pearson coefficient or Spearman's rho depending on the distribution of the data variables. Results: Sixty subjects and caregivers were enrolled at 6 ICON centers; 52 were eligible for inclusion. The majority (40%) had Grade 1 bleeding. Most patients (82%) were seen in outpatient hematology clinic by the hematologist and had been referred by the emergency room (73%). The median time to consultation with a hematologist from onset of symptoms was 7 days (1-199) and the median time to diagnosis by hematologist from initial contact with a health care provider was 5 days (0-154). Most subjects had seen 2 health care providers prior to the hematologist. KIT proxy report cumulative scores were a mean of 76.03 (SD 14.72). There was no significant difference between the time to diagnosis or the time from initial encounter with health care provider to hematologist and initial level of worry (p=0.70 and 0.90, respectively). There was also no significant difference between the time to diagnosis or the time from initial encounter with health care provider to hematologist and KIT proxy scores (p=0.96 and 0.50, respectively). However, there was a significant decline in level of worry (scale 0-10) prior to the hematologist visit (median 8, range 1-10) to after the visit (median 4, range 1-10). The association between number of medical providers encountered prior to diagnosis and KIT proxy scores was not significant (p=0.45) (Table). Conclusions: In this study at 6 teaching institutions, we were unable to detect a significant difference in proxy-reported KIT scores relative to the number of health care providers seen or time from diagnosis until the first encounter with the hematologist. We were, however, able to detect a significant change in the level of caregiver worry pre- and post- visit with the pediatric hematologist, supporting a benefit of specialist care to the caregivers of children with ITP. This study was limited by its small sample size and retrospective design. ITP is considered a benign disease but is associated with a significant amount of worry and impact on QoL for patients and caregivers which warrants further investigation. Disclosures Lambert: CSL Behring: Consultancy; Amgen: Consultancy, Other; Bayer: Other: Ad boards; Novartis: Other: Ad boards, Research Funding; Shionogi: Consultancy; Kedrion: Consultancy; Sysmex: Consultancy; AstraZeneca: Research Funding; PDSA: Research Funding. Grace:Agios Pharmaceuticals, Inc: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Research Funding.

A Social-Ecological Approach to Determine Barriers of DMSM Practice For Patients with Type 2 Diabetes Mellitus: A literature review

2018 ◽  
Vol 1 (1) ◽  
pp. 1-20
Author(s):  
Andi Mayasari Usman ◽  
Rian Adi Pamungkas
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Diabetes Care ◽  
Diabetes Management ◽  
Self Management ◽  
Care Providers

Diabetes mellitus is one of the global problems the world. Since the complexity of the patient’s tasks is required in the diabetes care, the consistency to engage this various health behavior for addressing the glycemic control target is difficult to achieve. Failure management may reflect by patient, family, inadequate intervention strategies by health care provider as well as organization factor. Three databases used such as PubMed, MIDLINE, and CINAHL to address patient’s barriers, family’s barriers, and provider’s barriers as well as organization barriers for diabetes management. Patient’s attitudes and belief, knowledge, culture, and ethnicity, self-efficacy, financial resources and economic status, lack of Social Support Perceived, and lack of time may influence the diabetes self-management. Family factors lead to patients’ diabetes self-management such as lack of knowledge and skill to support patients in diabetes management and quality of the relationship between patients-family. Health care providers factors included beliefs, attitudes, knowledge and skill and patient–family-provider interaction and communication. Other factors lead to diabetes self-management and health care provider performance to provide the intervention from organization level such as integrated health system sufficiency health insurance to support resources. A deeper understanding of the barriers in diabetes management is necessary to improve the diabetes care and quality of health care services for patients with diabetes. Further research needs to consider these barriers before designing the effective, sensitive interventions and problem solving for diabetes care

scholarly journals Insights for rural health care provider retention : a quantitative survey analysis

2021 ◽  
Author(s):  
◽  
Maria Kuhns
Keyword(s):  
Health Care ◽  
Rural Communities ◽  
Rural Health ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Rural Health Care ◽  
Care Providers ◽  
The Impact

Due to rural health disparities and an uneven distribution of health providers across the rural urban continuum, retaining the existing rural health care provider workforce may be an important strategy to maintain existing rural health care provision. While a large body of literature addresses how to recruit health care providers to rural areas, less is known about how to retain these providers. Even less literature has focused on the role of rural communities in health care provider retention. In this thesis, I examine the role of provider background and familial characteristics, workplace characteristics, and community characteristics that may impact a provider's likelihood to consider leaving a rural community. I use data from a survey of over 900 rural health care providers across nine states and a probit model to estimate the impact of these characteristics on a provider's propensity to consider leaving. I find that establishing social ties and integrating within the community through volunteering reduces providers' likelihood to consider leaving by 10 percent. Additionally, providers who engage in entrepreneurship by investing in part or all of their practice are 12 percent less likely to consider leaving, all else being equal. I also find that having unacceptable on-call responsibilities increases a provider's likelihood to consider leaving by 17 percent. This thesis contributes to the existing literature by estimating the effects of work-life balance, entrepreneurship, and the role of family and personal integration on provider retention. Furthermore, it emphasizes the role of communities in provider retention. These results offer insights to rural communities and decision-makers seeking to identify how to maintain their existing rural health care workforce.

Men with adult-onset epilepsy: Their experiences of health care provider relationship qualities following neurosurgery

2020 ◽  
Vol 26 (2) ◽  
pp. 105-119
Author(s):  
Martin Raffaele ◽  
Charity Tinofirei
Keyword(s):  
Health Care ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Well Being ◽  
Subjective Well Being ◽  
Adult Onset ◽  
Care Providers ◽  
Professional Relationship

AbstractThe success of a lobectomy procedure for adult-onset epileptic seizure (AOES) would depend on the quality of the patient’s relationship with the health care provider. This ethnographic multiple case study explored patient and health professional relationship contexts following surgery for seizure activity reduction treatment. We interviewed five Australian men (aged 34–59) with a history of AOES and neurosurgery regarding the quality of their relationship with health care providers. Interpretive phenomenological analysis (IPA) of the data yielded three interrelated relationship themes of Timeliness (promptness of necessary care), Support (availability, understanding, and empathy), and Responsibility (adaptive communication, self-care, and decision-making ownership). Self-directed relationship resourcing enhanced subjective well-being in the patients.

scholarly journals Modelling health care customer satisfaction: Evidence from Serbia

2021 ◽  
Vol 16 (1) ◽  
pp. 125-145
Author(s):  
Tamara Rajić ◽  
Ana Rakić ◽  
Isidora Milošević
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Theory And Practice ◽  
Care Providers ◽  
Convenience Sample ◽  
Behavioural Intentions ◽  
The Impact

Customer loyalty, with satisfaction of customers as its main precondition, has long been regarded as an overarching goal of service businesses. With the proliferation of health care providers, which brought about rising competitive pressures on the market, the issue of how to satisfy and keep patients has been attracting increasing attention of researchers and health care management. Therefore, this study aims to examine the antecedents of patient satisfaction and its direct and mediated impact on patients' behavioural intentions in thus far under-studied context of emerging economy's health care system. The study has been conducted in a primary health care setting, on a convenience sample of 300 patients, by means of structured questionnaire. The application of structural equation modelling (SEM) revealed direct impact of health care service quality on patient satisfaction and its mediated impact on satisfaction, via perceived value of health care services. In addition to direct influence of satisfaction on patients' behavioural intentions, its total effect on positive intentions of patients is increased by the impact of patient commitment to a health care provider, which, as evidenced by this study's findings, increases with patient's rising trust into a health care provider. Implications for theory and practice are discussed and further research directions are provided.

Is routine administration of standardized questionnaires that assess aspects of patients’ quality of life justified in medical oncology clinics?

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e20501-e20501
Author(s):  
Khalid A. Al-Saleh
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Care Providers ◽  
Randomized Controlled ◽  
Use Of Resources ◽  
Routine Administration

e20501 Background: increasing interest in the Quality of Life outcomes in cancer patients led to increase implementation of their use in routine clinical practice. The aim of this study is to review the scientific evidence behind recommending the use of quality of life (QoL) scales routinely in outpatient evaluation. Methods: systematic review for all published randomized controlled trials in English language between January 1, 1990 till December 1, 2010. Out of 479 articles (468 identified by electronic search + 11 articles identified by manual search), six trials satisfied the eligibility criteria: 1) the study was a randomized controlled trial (RCT) with randomization of patients or health care providers; 2) the findings of the administered questionnaire or scale (the intervention) were given to health care provider, and compared to standard care with no questionnaire administered (the control); 3) study was conducted in outpatient oncology clinics; and 4) an outcome was measured that related to i) QoL improvement, ii) reduction in morbidity, iii) reduction in stress for the patients, iv) improvement in communication between patients and health care provider, or v) improved patient satisfaction. Assessment for the quality of the study was done using the GRADE methodology. Results: serious methodological issues were affecting most of the trials. Overall the evaluation of the quality of the evidence from these identified trials suggests that there is a weak recommendation to use QoL scales in routine oncology practice to improve communication between physicians and patients. Conclusions: The routine use of such tools in the outpatient settings at improving the patient outcome or satisfaction cannot be recommended based on the available evidence. The potential harm with the excess use of resources needed to implement, collect, store, analyse, and present such data to health care providers should be also considered. Further research and better designed trials is required using recent methodological techniques (such as item-response theory based questionnaire and cluster randomization) might help to reach an answer to this question.

Impact of a Laryngectomy on Quality of Life: Perspective of the Patient versus That of the Health Care Provider

1997 ◽  
Vol 106 (8) ◽  
pp. 693-699 ◽  
Author(s):  
Randal A. Otto ◽  
Valerie Lawrence ◽  
Robert A. Dobie ◽  
Connie Sakai
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Life Expectancy ◽  
Health Care Providers ◽  
Care Provider ◽  
Care Providers ◽  
Trade Off ◽  
Laryngeal Preservation ◽  
The Impact

This study retrospectively assesses the impact of laryngectomy on the quality of life of 46 patients as compared to the perception of the impact of laryngectomy of 13 health care providers (HCPs). Employing the “time trade-off methodology, we assessed patient and HCP preferences and calculated estimated utilities. We found that 20% of patients would be willing to compromise anticipated life expectancy to preserve voice or preoperative quality of life. By comparison, 46% of the HCPs perceived that their patients would be willing to accept a reduced life span in order to preserve their larynx and quality of life. In conclusion, the percentage of HCPs who believed their patients would compromise survival was substantially higher than the percentage of actual patients who expressed this preference. This perception may influence physicians' attitudes toward recommending laryngeal preservation therapy for their patients. For most laryngectomy patients, treatments attempting laryngeal preservation, particularly if associated with compromised survival, may not be warranted.

scholarly journals A comparison of women’s expectations of labour and birth with the experiences in primiparas and multiparas with normal vaginal delivery

2016 ◽  
Vol 4 (1) ◽  
pp. 16-25 ◽  
Author(s):  
Manijeh Pirdil ◽  
Leila Pirdel
Keyword(s):  
Health Care ◽  
Vaginal Delivery ◽  
Health Care Providers ◽  
Normal Vaginal Delivery ◽  
Care Providers ◽  
Medical College ◽  
Childbirth Experience ◽  
Significant Difference ◽  
Negative Expectations

Background: Maternal childbirth expectations play an important role in determining a woman’s response to her childbirth experience. Women need to be helped to develop realistic and positive expectations and identify the factors that influence these expectations.Objective: The aim of this study was to compare woman’s expectations and experiences of childbirth.Methods: This descriptive-comparative study was carried out in Tabriz Alzahra Hospital from 2006 to 2007. For this purpose, a total of 600 primiparas and multiparas women who were candidates for vaginal delivery, were randomly selected and interviewed. The data were collected by questionnaire.Results: Comparison of the means of mothers expectation and experience of labor and birth between the two groups demonstrated a statistically significant difference (p<0.05). The findings indicated a number of differences exist between primiparas and multiparas women in relation to expectations and experiences of birth when compare two groups. The majority of women had negative expectations and experiences of childbirth.Conclusion: The evaluation and understanding of birth expectations and experiences as positive and negative is priority of maternity system. Antenatal educators need to ensure that pregnant women are appropriately prepared for what might actually happen to limit this expectation-experience gap. Health-care providers should improve the quality of antenatal care which can change negative childbirth expectations and experiences of womenJournal of Kathmandu Medical College, Vol. 4(1) 2015, 16-25

scholarly journals A Personalized Approach of Patient–Health Care Provider Communication Regarding Colorectal Cancer Screening Options

2018 ◽  
Vol 38 (5) ◽  
pp. 601-613 ◽  
Author(s):  
M. Gabriela Sava ◽  
James G. Dolan ◽  
Jerrold H. May ◽  
Luis G. Vargas
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Medical Decision ◽  
Average Risk ◽  
Care Providers

Background. Current colorectal cancer screening guidelines by the US Preventive Services Task Force endorse multiple options for average-risk patients and recommend that screening choices should be guided by individual patient preferences. Implementing these recommendations in practice is challenging because they depend on accurate and efficient elicitation and assessment of preferences from patients who are facing a novel task. Objective. To present a methodology for analyzing the sensitivity and stability of a patient’s preferences regarding colorectal cancer screening options and to provide a starting point for a personalized discussion between the patient and the health care provider about the selection of the appropriate screening option. Methods. This research is a secondary analysis of patient preference data collected as part of a previous study. We propose new measures of preference sensitivity and stability that can be used to determine if additional information provided would result in a change to the initially most preferred colorectal cancer screening option. Results. Illustrative results of applying the methodology to the preferences of 2 patients, of different ages, are provided. The results show that different combinations of screening options are viable for each patient and that the health care provider should emphasize different information during the medical decision-making process. Conclusion. Sensitivity and stability analysis can supply health care providers with key topics to focus on when communicating with a patient and the degree of emphasis to place on each of them to accomplish specific goals. The insights provided by the analysis can be used by health care providers to approach communication with patients in a more personalized way, by taking into consideration patients’ preferences before adding their own expertise to the discussion.

Risky Business: Proposed Reform of the Antitrust Laws As Applied to Health Care Provider Networks

1998 ◽  
Vol 24 (1) ◽  
pp. 59-87
Author(s):  
Natalie Marjancik
Keyword(s):  
Health Care ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Health Care Services ◽  
Care Delivery ◽  
Antitrust Enforcement ◽  
Care Providers ◽  
Antitrust Laws ◽  
Provider Networks

Because the health care industry comprises over thirteen percent of the American economy, law enforcers increasingly apply antitrust law to all aspects of health care delivery and financing. Through antitrust enforcement, consumers receive the benefits of lower health care costs and improved health care services. To achieve further cost savings, health care providers are forming, as well as joining, many different types of provider network joint ventures. Providers form networks, expect ing “them to generate efficiencies, reduce excess capacity, improve utilization, permit greater specialization and enhance quality.” However, because they organize competing physicians and enable them to collaborate on prices and set fee schedules, provider networks raise serious antitrust concerns. Consequently, the federal government and courts are increasingly focusing their antitrust enforcement efforts on the formation and anticompetitive activities of provider networks.In Part I, this Note addresses the degree to which network providers must be economically and financially integrated to legally collaborate and set prices. Part II briefly explains the procedures one may use to enforce the federal antitrust laws. Following this explanation of antitrust enforcement procedures, Part III discusses the relevant statutory and case law applicable to health care provider networks.

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