TANDEM (Tailored intervention for ANxiety and DEpression Management in COPD) trial: Qualitative interviews with health care professionals from the pilot phase

Author(s):  
Clarisse Dibao-Dina ◽  
Stephanie Taylor ◽  
Hilary Pinnock ◽  
Elizabeth Steed ◽  
Sarah Saqi-Waseem ◽  
...  
2017 ◽  
Author(s):  
Svenja Litzkendorf ◽  
Tobias Hartz ◽  
Jens Göbel ◽  
Holger Storf ◽  
Frédéric Pauer ◽  
...  

BACKGROUND Recently, public and political interest has focused on people living with rare diseases and their health concerns. Due to the large number of different types of rare diseases and the sizable number of patients, taking action to improve the life of those affected is gaining importance. In 2013, the federal government of Germany adopted a national action plan for rare diseases, including the call to establish a central information portal on rare diseases (Zentrales Informationsportal über seltene Erkrankungen, ZIPSE). OBJECTIVE The objective of this study, therefore, was to conduct scientific research on how such a portal must be designed to meet the needs of patients, their families, and medical professionals, and to provide high-quality information for information seekers. METHODS We chose a 3-step procedure to develop a needs-based prototype of a central information portal. In the first step, we determined the information needs of patients with rare diseases, their relatives, and health care professionals by means of qualitative interviews and their content-analytical evaluation. On the basis of this, we developed the basic structure of the portal. In the second step, we identified quality criteria for websites on rare diseases to ensure that the information linked with ZIPSE meets the quality demands. Therefore, we gathered existing criteria catalogs and discussed them in an expert workshop. In the third step, we implemented and tested the developed prototypical information portal. RESULTS A portal page was configured and made accessible on the Web. The structure of ZIPSE was based on the findings from 108 qualitative interviews with patients, their relatives, and health care professionals, through which numerous information needs were identified. We placed particularly important areas of information, such as symptoms, therapy, research, and advisory services, on the start page. Moreover, we defined 13 quality criteria, referring to factors such as author information, creation date, and privacy, enabling links with high-quality information. Moreover, 19 users tested all the developed routines based on usability and comprehensibility. Subsequently, we improved the visual presentation of search results and other important search functions. CONCLUSIONS The implemented information portal, ZIPSE, provides high-quality information on rare diseases from a central point of access. By integrating the targeted groups as well as different experts on medical information during the construction, the website can assure an improved search for information for users. ZIPSE can also serve as a model for other Web-based information systems in the field of rare diseases. REGISTERED REPORT IDENTIFIER RR1-10.2196/7425


2017 ◽  
Vol 32 (1) ◽  
pp. 23-35 ◽  
Author(s):  
Katherine Bristowe ◽  
Matthew Hodson ◽  
Bee Wee ◽  
Kathryn Almack ◽  
Katherine Johnson ◽  
...  

Background: Lesbian, gay, bisexual and/or trans (LGBT) people have higher risk of certain life-limiting illnesses and unmet needs in advanced illness and bereavement. ACCESSCare is the first national study to examine in depth the experiences of LGBT people facing advanced illness. Aim: To explore health-care experiences of LGBT people facing advanced illness to elicit views regarding sharing identity (sexual orientation/gender history), accessing services, discrimination/exclusion and best-practice examples. Design: Semi-structured in-depth qualitative interviews analysed using thematic analysis. Setting/participants: In total, 40 LGBT people from across the United Kingdom facing advanced illness: cancer ( n = 21), non-cancer ( n = 16) and both a cancer and a non-cancer conditions ( n = 3). Results: In total, five main themes emerged: (1) person-centred care needs that may require additional/different consideration for LGBT people (including different social support structures and additional legal concerns), (2) service level or interactional (created in the consultation) barriers/stressors (including heteronormative assumptions and homophobic/transphobic behaviours), (3) invisible barriers/stressors (including the historical context of pathology/criminalisation, fears and experiences of discrimination) and (4) service level or interactional facilitators (including acknowledging and including partners in critical discussions). These all shape (5) individuals’ preferences for disclosing identity. Prior experiences of discrimination or violence, in response to disclosure, were carried into future care interactions and heightened with the frailty of advanced illness. Conclusion: Despite recent legislative change, experiences of discrimination and exclusion in health care persist for LGBT people. Ten recommendations, for health-care professionals and services/institutions, are made from the data. These are simple, low cost and offer potential gains in access to, and outcomes of, care for LGBT people.


2018 ◽  
Vol 6 (4) ◽  
pp. 1-260 ◽  
Author(s):  
Elaine Hay ◽  
Krysia Dziedzic ◽  
Nadine Foster ◽  
George Peat ◽  
Danielle van der Windt ◽  
...  

BackgroundOsteoarthritis (OA) is the most common long-term condition managed in UK general practice. However, care is suboptimal despite evidence that primary care and community-based interventions can reduce OA pain and disability.ObjectivesThe overall aim was to improve primary care management of OA and the health of patients with OA. Four parallel linked workstreams aimed to (1) develop a health economic decision model for estimating the potential for cost-effective delivery of primary care OA interventions to improve population health, (2) develop and evaluate new health-care models for delivery of core treatments and support for self-management among primary care consulters with OA, and to investigate prioritisation and implementation of OA care among the public, patients, doctors, health-care professionals and NHS trusts, (3) determine the effectiveness of strategies to optimise specific components of core OA treatment using the example of exercise and (4) investigate the effect of interventions to tackle barriers to core OA treatment, using the example of comorbid anxiety and depression in persons with OA.Data sourcesThe North Staffordshire Osteoarthritis Project database, held by Keele University, was the source of data for secondary analyses in workstream 1.MethodsWorkstream 1 used meta-analysis and synthesis of published evidence about effectiveness of primary care treatments, combined with secondary analysis of existing longitudinal population-based cohort data, to identify predictors of poor long-term outcome (prognostic factors) and design a health economic decision model to estimate cost-effectiveness of different hypothetical strategies for implementing optimal primary care for patients with OA. Workstream 2 used mixed methods to (1) develop and test a ‘model OA consultation’ for primary care health-care professionals (qualitative interviews, consensus, training and evaluation) and (2) evaluate the combined effect of a computerised ‘pop-up’ guideline for general practitioners (GPs) in the consultation and implementing the model OA consultation on practice and patient outcomes (parallel group intervention study). Workstream 3 developed and investigated in a randomised controlled trial (RCT) how to optimise the effect of exercise in persons with knee OA by tailoring it to the individual and improving adherence. Workstream 4 developed and investigated in a cluster RCT the extent to which screening patients for comorbid anxiety and depression can improve OA outcomes. Public and patient involvement included proposal development, project steering and analysis. An OA forum involved public, patient, health professional, social care and researcher representatives to debate the results and formulate proposals for wider implementation and dissemination.ResultsThis programme provides evidence (1) that economic modelling can be used in OA to extrapolate findings of cost-effectiveness beyond the short-term outcomes of clinical trials, (2) about ways of implementing support for self-management and models of optimal primary care informed by National Institute for Health and Care Excellence recommendations, including the beneficial effects of training in a model OA consultation on GP behaviour and of pop-up screens in GP consultations on the quality of prescribing, (3) against adding enhanced interventions to current effective physiotherapy-led exercise for knee OA and (4) against screening for anxiety and depression in patients with musculoskeletal pain as an addition to current best practice for OA.ConclusionsImplementation of evidence-based care for patients with OA is feasible in general practice and has an immediate impact on improving the quality of care delivered to patients. However, improved levels of quality of care, changes to current best practice physiotherapy and successful introduction of psychological screening, as achieved by this programme, did not substantially reduce patients’ pain and disability. This poses important challenges for clinical practice and OA research.LimitationsThe key limitation in this work is the lack of improvement in patient-reported pain and disability despite clear evidence of enhanced delivery of evidence-based care.Future work recommendations(1) New thinking and research is needed into the achievable and desirable long-term goals of care for people with OA, (2) continuing investigation into the resources needed to properly implement clinical guidelines for management of OA as a long-term condition, such as regular monitoring to maintain exercise and physical activity and (3) new research to identify subgroups of patients with OA as a basis for stratified primary care including (i) those with good prognosis who can self-manage with minimal investigation or specialist treatment, (ii) those who will respond to, and benefit from, specific interventions in primary care, such as physiotherapy-led exercise, and (iii) develop research into effective identification and treatment of clinically important anxiety and depression in patients with OA and into the effects of pain management on psychological outcomes in patients with OA.Trial registrationCurrent Controlled Trials ISRCTN06984617, ISRCTN93634563 and ISRCTN40721988.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research Programme and will be published in full inProgramme Grants for Applied Research Programme; Vol. 6, No. 4. See the NIHR Journals Library website for further project information.


2016 ◽  
Vol 12 (4) ◽  
pp. 225-237 ◽  
Author(s):  
Kia Ditlevsen ◽  
Annemette Nielsen

Purpose The purpose of this paper is to provide knowledge on barriers to preventive action on early childhood overweight in non-western migrant families. It investigates the underlying understandings of the parental role in relation to weight control present in health-care professionals and in families. Design/methodology/approach The study is based on qualitative interviews with parents who are engaged in interventions aimed at helping them and their children to adopt a healthier life style, and on interviews with health-care professionals. Findings This study shows that the participating parents, all low SES and living under different forms of insecurity, perceived their parental task for the present as creating well-being for their children, and they were, therefore, reluctant to enforce dietary changes. The health-care professionals, in contrast, considered the need for change through a perspective on future risks. Research limitations/implications The results are based on a rather small sample and the link between insecurity, family dynamics and health practice needs further research. Originality/value The participating parents represented a group that is rarely included in scientific research and the study, therefore, contributes valuable knowledge on health behavior in ethnic minority families. The empirical analysis provides new insights for health professionals regarding the suitability of the universal model of parental feeding styles. It illuminates the implications of implicitly applying this model in health interventions which involve vulnerable categories of parents such as refugees to western societies.


2018 ◽  
Author(s):  
Birthe Dinesen ◽  
Helle Spindler

BACKGROUND Cardiovascular disease is a leading cause of death globally causing 31% of all deaths worldwide. The Danish health care system is characterized by fragmented delivery of services and rehabilitation activities. The Teledialog Telerehabilitation Program for cardiac patients was developed and tested to rectify fragmentation and improve the quality of care. The Teledialog program was based on the assumption that a common communication platform shared by health care professionals, patients, and relatives could reduce or eliminate the fragmentation in the rehabilitation process and improve cooperation between the health professionals. OBJECTIVE This study aimed to assess the interorganizational cooperation between health care professionals across sectors (hospitals, municipal health care centers) in a cardiac telerehabilitation program. METHODS Theories of networks between organizations, the sociology of professions, and the “community of practice” approach were used in a case study of a cardiac telerehabilitation program. A triangulation of data collection techniques were used including documents, participant observation (n=76 hours), and qualitative interviews with healthcare professionals (n=37). Data were analyzed using NVivo 11.0. RESULTS The case study of cooperation in an interorganizational context of cardiac telerehabilitation program is characterized by the following key themes and patterns: (1) integrated workflows via a shared digital rehabilitation plan that help integrate workflow between health care professions and organizations, (2) joint clinical practice showed as a community of practice in telerehabilitation developed across professions and organizations, and (3) unifying the organizations as cooperation has advanced via a joint telerehabilitation program across municipalities and hospitals. CONCLUSIONS The Teledialog Telerehabilitation Program was a new innovative cardiac program tested on a large scale across hospitals, health care centers, and municipalities. Assessments showed that the Teledialog program and its associated technologies helped improve interorganizational cooperation and reduce fragmentation. The program helped integrate the organizations and led to the creation of a community of practice. Further research is needed to explore long-term effects of implementation of telerehabilitation technologies and programs. CLINICALTRIAL ClinicalTrials.gov NCT01752192; http://clinicaltrials.gov/ct2/show/NCT01752192 (Archived by WebCite at http://www.webcitation.org/6yR3tdEpb)


2020 ◽  
Author(s):  
Sumbal Shahbaz ◽  
Muhammad Zeshan Ashraf ◽  
Rubeena Zakar ◽  
Florian Fischer

Abstract Background: The novel coronavirus disease (COVID-19) is disseminating rapidly, increasing stress and challenges for health care professionals around the world. This study aims to discover the psychosocial challenges faced by female health care professionals (HCPs) treating COVID-19 patients in Pakistan.Methods: Using an empirical phenomenological methodology, semi-structured telephone-based qualitative interviews were taken from 22 female HCPs who were providing their expertise for COVID-19 patients in tertiary level hospitals of Lahore, Pakistan. Purposive sampling has been used for recruitment. The interviews were taken from July 20 to August 20, 2020. The interviews were analysed using thematic analysis.Results: This study discovered the psychosocial challenges faced by female HCPs serving COVID-19 patients. Five themes have been observed in the interviews: psychological concerns of HCPs while treating COVID-19 patients; feelings towards COVID-19 patients; confidence in government, administration and self-reflection; challenges as female HCPs and coping strategies; and finally, future concerns and recommendations. Many of these themes have also been linked with cultural issues, making the results specific for Pakistan.Conclusions: During the COVID-19 pandemic, female front-line HCPs have faced immense psychosocial pressure, starting from unsupportive family norms to unwelcoming working environment and insensitive hospital administration. Moreover, rumours among general public, lack of proper training, missing incentives and improper system surveillance had increased the anxiety and stress among HCPs. Hence, legislators are advised to take appropriate actions countrywide in order to improve the still on-going challenges and to support female HCPs in their working environment.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Helen Hurst ◽  
Jane Griffiths ◽  
Carrie Hunt ◽  
Ellen Martinez

Abstract Background Open visiting refers to the principle of unrestricted visiting hours in the hospital setting to enable relatives, families and carers to visit at any time. There has been recognition that open visiting supports the principle of patient and family supported care and improves communication. Despite this there has been difficulty in implementing open visiting and barriers identified. The aims of this study were therefore to evaluate the implementation of open visiting, the barriers to implementation, sustainability and the impact of open visiting on communication between health care professionals, families and carers. Methods The study was conducted on two large acute wards for the older person. Realist evaluation methods were used to understand ‘what works well, how, for whom and to what extent.’ Mixed methods were employed including qualitative interviews and descriptive analyses of routine data sets. Following the methodology of realist evaluation, programme theories were identified a long with the context, mechanisms and outcomes of implementation, to better understand the implementation process. Results The results of this study identified some key findings, demonstrating that open visiting does improve communication and can help to build trusting relationships between families/carers and health care professionals (HCP). Barriers to implementation were based on the belief that it would impinge on routines within the ward setting. To achieve the principles of patient and family/carer centred care, the key mechanisms are the confidence and skills of individual nurses and health care assistants to engage with relatives/carers, whilst retaining a sense of control, particularly when care is being delivered to other patients. Conclusion In summary, open visiting creates a positive culture which fosters better relationships between families/carers and HCPs. Involving families/carers as partners in care does not happen automatically in an environment where open visiting is the policy, but requires engagement with staff to encourage and support relatives/carers.


Author(s):  
Jessica Scharf ◽  
Peter Angerer ◽  
Gesine Müting ◽  
Adrian Loerbroks

Common mental disorders (CMDs) are risk factors for long-term sickness absence and unemployment. Therefore, return-to-work (RTW) processes have been introduced to facilitate the return of employees. As the success of RTW processes is considered to be determined by the cooperativeness of the involved stakeholders, we aimed to investigate the views of those stakeholders to disclose potentially diverging expectations. Qualitative interviews were conducted (08/2018-04/2019) among five stakeholder groups: returnees with a diagnosed CMD who were eligible for a RTW process; health care professionals nominated by the returnees; supervisors, colleagues and occupational physicians (the latter three groups were not nominated by the returnees). In total, 24 returnees, 13 health care professionals, 13 occupational physicians, 9 supervisors and 9 colleagues were interviewed (68 interviews in total). Potentially diverging expectations of the stakeholders related to whether diagnoses need to be disclosed by returnees. Agreement existed in terms of the need for a trustful relationship between employees and occupational physicians to initiate a RTW process early. As the understanding of all stakeholders’ viewpoints is one of the main factors promoting a successful RTW, we explored the expectations of those involved in the RTW process. One implication of our findings is to strengthen the role of occupational physicians, who could coordinate the return process.


2022 ◽  
Vol 21 (1) ◽  
Author(s):  
C. Bausewein ◽  
F. Hodiamont ◽  
N. Berges ◽  
A. Ullrich ◽  
C. Gerlach ◽  
...  

Abstract Background In the SARS-CoV-2 pandemic, general and specialist Palliative Care (PC) plays an essential role in health care, contributing to symptom control, psycho-social support, and providing support in complex decision making. Numbers of COVID-19 related deaths have recently increased demanding more palliative care input. Also, the pandemic impacts on palliative care for non-COVID-19 patients. Strategies on the care for seriously ill and dying people in pandemic times are lacking. Therefore, the program ‘Palliative care in Pandemics’ (PallPan) aims to develop and consent a national pandemic plan for the care of seriously ill and dying adults and their informal carers in pandemics including (a) guidance for generalist and specialist palliative care of patients with and without SARS-CoV-2 infections on the micro, meso and macro level, (b) collection and development of information material for an online platform, and (c) identification of variables and research questions on palliative care in pandemics for the national pandemic cohort network (NAPKON). Methods Mixed-methods project including ten work packages conducting (online) surveys and qualitative interviews to explore and describe i) experiences and burden of patients (with/without SARS-CoV-2 infection) and their relatives, ii) experiences, challenges and potential solutions of health care professionals, stakeholders and decision makers during the SARS-CoV-2 pandemic. The work package results inform the development of a consensus-based guidance. In addition, best practice examples and relevant literature will be collected and variables for data collection identified. Discussion For a future “pandemic preparedness” national and international recommendations and concepts for the care of severely ill and dying people are necessary considering both generalist and specialist palliative care in the home care and inpatient setting.


Author(s):  
Syed Muhammad Ali ◽  
Sidrah Nausheen

Objectives: To assess anxiety and depression symptoms during the coronavirus pandemic among health care professionals in Pakistan. Methods: This is a cross-sectional study where a questionnaire containing demographics, and a validated fear scale, depression, and anxiety scale was made on Google drive and was sent to health care workers as doctors, nurses, and paramedical staff working in six different hospitals in Pakistan, through What's app on smartphones from May 1 to Jun 30, 2020. Data was analyzed on SPSS. Results: The response rate was 80%. Of 400 participants, 263 (65.8%) were physicians, and 137 (34.0%) were nurses and paramedical staff.  57.0% were less than 40 years, whereas 18.3% were more than 50 years of age. Majority of participants 65.5 % (n= 262) experienced moderate level of fear and 16.5% (n= 66) had high level of fear. 19% feared death. 57.0% reported social media to be responsible for increasing their fear. On the depression and anxiety scale, 22.0% (n=87) reported moderate to severe depression and anxiety symptoms. A significant relationship was demonstrated between the depression level and age, education, profession (p < 0.001). Similarly, anxiety and depression scores were strongly related to the availability of Personal Protective Equipment (p< 0.001). Conclusion: 22.0% of healthcare professionals are suffering from moderate to severe anxiety and depression symptoms, whereas 65.0% had moderate symptoms of fear. The predictors are age, education level, and co-morbidities. A high level of fear, anxiety, and depression raises concern for their psychological well-being through different programs. Keywords: COVID-19; Healthcare workers; Psychosocial


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