Understanding patient outcomes to develop a multimorbidity adapted patient-reported outcomes measure: a qualitative description of patient and provider perspectives

Abstract Background Multimorbidity is a complex health situation that requires interventions tailored to patient needs; the outcomes of such interventions are difficult to evaluate. The purpose of this study was to describe the outcomes of patient-centred interventions for people with multimorbidity from the patients’ and healthcare providers’ perspectives. Methods This study followed a qualitative descriptive design. Nine patients with multimorbidity and 18 healthcare professionals (nurses, general practitioners, nutritionists, and physical and respiratory therapists), participating in a multimorbidity-adapted intervention in primary care were recruited. Data were collected using semi-structured interviews with 12 open-ended questions. Triangulation of disciplines among interviewers, research team debriefing, data saturation assessment and iterative data collection and analysis ensured a rigorous research process. Results Outcome constructs described by participants covered a wide range of themes and were grouped into seven outcome domains: Health Management, Physical Health, Functional Status, Psychosocial Health, Health-related Behaviours, General Health and Health Services. The description of constructs by stakeholders provides valuable insight on how outcomes are experienced and worded by patients. Conclusion Participants described a wide range of outcome constructs, which were relevant to and observable by patients and were in line with the clinical reality. The description provides a portrait of multimorbidity-adapted intervention outcomes that are significant for the selection and development of clinical research outcome measures.

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Understanding Patient Outcomes to Develop a Multimobidity Adapted Patient-reported Outcomes Measure: A Qualitative Description of Patient and Provider Perspectives.

10.21203/rs.3.rs-55462/v1 ◽

2020 ◽

Author(s):

Maxime Sasseville ◽

Maud-Chrisitne Chouinard ◽

Martin Fortin

Keyword(s):

Health Management ◽

Psychosocial Health ◽

Research Process ◽

Physical Symptoms ◽

Qualitative Description ◽

Valuable Insight ◽

Structured Interviews ◽

Provider Perspectives ◽

Wide Range ◽

Patient Reported

Abstract Background: Understanding the outcomes of multimorbidity-adapted interventions from the perspective of patients and providers is essential to research and practice in this population, but is currently lacking. The purpose of this study was to describe the outcomes of patient-centred interventions for people with multimorbidity from the patients’ and providers’ perspectives.Methods: This study followed a qualitative descriptive design. Nine patients with multimorbidity and 18 healthcare professionals (nurses, general practitioners, nutritionists, and physical and respiratory therapists), participating in a multimorbidity-adapted intervention in primary care were recruited. Data was collected using semi-structured interviews with 12 open-ended questions. Triangulation of disciplines among interviewers, research team debriefing, data saturation assessment and iterative data collection and analysis ensured a rigorous research process.Results: Outcome constructs described by participants covered a wide range of themes and were grouped into seven outcome domains: Health Management, Functional Status, Physical Symptoms, Psychosocial Health, Health-oriented Behaviours, General Health and Health Services. The description of constructs by stakeholders provides valuable insight on how outcomes are experienced and worded by patients in that context.Conclusion: Stakeholders described a wide range of outcome constructs, which were relevant to and observable by patients and were in line with the clinical reality. The description provides a portrait of multimorbidity-adapted intervention outcomes that are significant for the selection and development of clinical research outcome measures.

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Understanding patient outcomes to develop a multimorbidity adapted patient-reported outcomes measure: a qualitative description of patient and provider perspectives.

10.21203/rs.3.rs-55462/v2 ◽

2021 ◽

Author(s):

Maxime Sasseville ◽

Maud-Christine Chouinard ◽

Martin Fortin

Keyword(s):

Health Management ◽

Healthcare Providers ◽

Psychosocial Health ◽

Qualitative Description ◽

Valuable Insight ◽

Structured Interviews ◽

Respiratory Therapists ◽

Wide Range ◽

Patient Reported ◽

Data Saturation

Abstract Background: Multimorbidity is a complex health situation that requires interventions tailored to patient needs; the outcomes of such interventions are difficult to evaluate. The purpose of this study was to describe the outcomes of patient-centred interventions for people with multimorbidity from the patients’ and healthcare providers’ perspectives.Methods: This study followed a qualitative descriptive design. Nine patients with multimorbidity and 18 healthcare professionals (nurses, general practitioners, nutritionists, and physical and respiratory therapists), participating in a multimorbidity-adapted intervention in primary care were recruited. Data were collected using semi-structured interviews with 12 open-ended questions. Triangulation of disciplines among interviewers, research team debriefing, data saturation assessment and iterative data collection and analysis ensured a rigorous research process.Results: Outcome constructs described by participants covered a wide range of themes and were grouped into seven outcome domains: Health Management, Physical Health, Functional Status, Psychosocial Health, Health-related Behaviours, General Health and Health Services. The description of constructs by stakeholders provides valuable insight on how outcomes are experienced and worded by patients.Conclusion: Participants described a wide range of outcome constructs, which were relevant to and observable by patients and were in line with the clinical reality. The description provides a portrait of multimorbidity-adapted intervention outcomes that are significant for the selection and development of clinical research outcome measures.

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Connected diagnostics to improve accurate diagnosis, treatment, and conditional payment of malaria services in Kenya

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-021-01600-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shannen M. C. van Duijn ◽

Angela K. Siteyi ◽

Sherzel Smith ◽

Emmanuel Milimo ◽

Leon Stijvers ◽

...

Keyword(s):

Clinical Performance ◽

Healthcare Providers ◽

Malaria Treatment ◽

Sub Saharan Africa ◽

Structured Interviews ◽

National Guidelines ◽

Private Providers ◽

Provider Perspectives ◽

Treatment Data ◽

Sub Saharan

Abstract Background In sub-Saharan Africa, the material and human capacity to diagnose patients reporting with fever to healthcare providers is largely insufficient. Febrile patients are typically treated presumptively with antimalarials and/or antibiotics. Such over-prescription can lead to drug resistance and involves unnecessary costs to the health system. International funding for malaria is currently not sufficient to control malaria. Transition to domestic funding is challenged by UHC efforts and recent COVID-19 outbreak. Herewith we present a digital approach to improve efficiencies in diagnosis and treatment of malaria in endemic Kisumu, Kenya: Connected Diagnostics. The objective of this study is to evaluate the feasibility, user experience and clinical performance of this approach in Kisumu. Methods Our intervention was performed Oct 2017–Dec 2018 across five private providers in Kisumu. Patients were enrolled on M-TIBA platform, diagnostic test results digitized, and only positive patients were digitally entitled to malaria treatment. Data on socio-demographics, healthcare transactions and medical outcomes were analysed using standard descriptive quantitative statistics. Provider perspectives were gathered by 19 semi-structured interviews. Results In total 11,689 febrile patients were digitally tested through five private providers. Malaria positivity ranged from 7.4 to 30.2% between providers, significantly more amongst the poor (p < 0.05). Prescription of antimalarials was substantially aberrant from National Guidelines, with 28% over-prescription (4.6–63.3% per provider) and prescription of branded versus generic antimalarials differing amongst facilities and correlating with the socioeconomic status of clients. Challenges were encountered transitioning from microscopy to RDT. Conclusion We provide full proof-of-concept of innovative Connected Diagnostics to use digitized malaria diagnostics to earmark digital entitlements for correct malaria treatment of patients. This approach has large cost-saving and quality improvement potential.

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White lie during patient care: A qualitative study of nurses’ perspectives

10.21203/rs.2.24636/v3 ◽

2020 ◽

Author(s):

Alireza Nikbakht nasrabadi ◽

soodabeh joolaee ◽

Elham Navab ◽

Maryam esmaeilie ◽

mahboobe shali

Keyword(s):

Qualitative Study ◽

Patient Care ◽

Healthcare Providers ◽

Cultural Knowledge ◽

Hospital Nurses ◽

Structured Interviews ◽

Related Factors ◽

Patient’S Rights ◽

Wide Range ◽

Data Saturation

Abstract Background: Keeping the patients well and fully informed about diagnosis, prognosis, and treatments is one of the patient’s rights in any healthcare system. Although all healthcare providers have the same viewpoint about rendering the truth in treatment process, sometimes the truth is not told to the patients; that is why the healthcare staff tell “white lie” instead. This study aimed to explore the nurses’ experience of white lies during patient care. Methods: This qualitative study was conducted from June to December 2018. Eighteen hospital nurses were recruited with maximum variation from ten state-run educational hospitals affiliated to Tehran University of Medical Sciences. Purposeful sampling was used and data were collected by semi-structured interviews that were continued until data saturation. Data were classified and analyzed by content analysis approach. Results: The data analysis in this study resulted in four main categories and eleven subcategories. The main categories included hope crisis, bad news, cultural diversity, and nurses’ limited professional competences. Conclusion: Results of the present study showed that, white lie told by nurses during patient care may be due to a wide range of patient, nurse and/or organizational related factors. Communication was the main factor that influenced information rendering. Nurses’ communication with patients should be based on mutual respect, trust and adequate cultural knowledge, and also nurses should provide precise information to patients, so that they can make accurate decisions regarding their health care.

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Exploring the Knowledge, Attitudes, and Behavioural Responses of Healthcare Students towards Mental Illnesses—A Qualitative Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17010025 ◽

2019 ◽

Vol 17 (1) ◽

pp. 25 ◽

Cited By ~ 6

Author(s):

Taylor Riffel ◽

Shu-Ping Chen

Keyword(s):

Mental Health ◽

Mental Illness ◽

Healthcare Professionals ◽

Health Knowledge ◽

Healthcare Providers ◽

Mental Illnesses ◽

Qualitative Description ◽

Mental Illness Stigma ◽

Structured Interviews ◽

Behavioural Responses

Background: The stigma of mental illness causes delays in seeking help, and often compromises victims’ therapeutic relationships with healthcare providers. The knowledge, attitudes, and behavioural responses of future healthcare professionals toward individuals with mental illnesses are explored here to suggest steps that will reduce mental illness stigma in healthcare providers. Methods: A generic qualitative approach—Qualitative Description—was used. Eighteen students from nine healthcare programs at a Canadian University participated in individual semi-structured interviews. Participants answered questions regarding their knowledge, attitudes, and behavioural responses towards individuals with mental illnesses. Thematic content analysis guided the data analysis. Results: Four main themes were constructed from the data: positive and negative general perceptions toward mental illness; contact experiences with mental illnesses; mental illness in a healthcare setting; and learning about mental illness in healthcare academia. Conclusions: Students showed well-rounded mental health knowledge and mostly positive behaviours toward individuals with mental illnesses. However, some students hold stigmatizing attitudes and do not feel prepared through their academic experiences to work with individuals with mental illnesses. Mental health education can reduce the stigma toward mental illness and improve the care delivered by healthcare professionals.

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“I am a healthcare practitioner”: A qualitative exploration of massage therapists’ professional identity

Journal of Complementary and Integrative Medicine ◽

10.1515/jcim-2019-0067 ◽

2019 ◽

Vol 17 (2) ◽

Cited By ~ 1

Author(s):

Amanda Baskwill ◽

Meredith Vanstone ◽

Del Harnish ◽

Kelly Dore

Keyword(s):

Professional Identity ◽

Service Providers ◽

Patient Empowerment ◽

Healthcare Providers ◽

Qualitative Description ◽

Future Research ◽

Structured Interviews ◽

Massage Therapist ◽

Individualized Care ◽

Massage Therapists

AbstractBackgroundA division has been described among massage therapists, some who identify as healthcare providers while others identify as service providers. The perceived division creates confusion about what it means to be a massage therapist.ObjectiveThis qualitative study answered, “How do massage therapists in Ontario describe their professional identity?”MethodsQualitative description (QD) was used and data were collected from 33 massage therapists using semi-structured interviews.ResultsThe resulting description of massage therapists’ identity in Ontario is the first of its kind. The identity described includes passion as professional motivation in practice, the importance of confidence and competence, a focus on the therapeutic relationship, individualized care, and patient empowerment, and a desire to be recognized for their role within the healthcare system.ConclusionThere is still much to be investigated about massage therapists’ identity. Future research will explore whether this description resonates with a larger sample of massage therapists in Ontario.

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Provider perspectives on demand creation for maternal vaccines in Kenya

Gates Open Research ◽

10.12688/gatesopenres.12833.1 ◽

2018 ◽

Vol 2 ◽

pp. 34 ◽

Cited By ~ 1

Author(s):

Irina Bergenfeld ◽

Stacy W. Nganga ◽

Courtni A. Andrews ◽

Vincent L. Fenimore ◽

Nancy A. Otieno ◽

...

Keyword(s):

Patient Education ◽

Healthcare Providers ◽

Immunization Coverage ◽

Provider Education ◽

Structured Interviews ◽

Maternal Immunization ◽

Provider Perspectives ◽

Demand Creation ◽

Print Materials ◽

Cultural Leaders

Background. Expansion of maternal immunization, which offers some of the most effective protection against morbidity and mortality in pregnant women and neonates, requires broad acceptance by healthcare providers and their patients. We aimed to describe issues surrounding acceptance and demand creation for maternal vaccines in Kenya from a provider perspective. Methods. Nurses and clinical officers were recruited for semi-structured interviews covering resources for vaccine delivery, patient education, knowledge and attitudes surrounding maternal vaccines, and opportunities for demand creation for new vaccines. Interviews were conducted in English and Swahili, transcribed verbatim from audio recordings, and analyzed using codes developed from interview guide questions and emergent themes. Results. Providers expressed favorable attitudes about currently available maternal immunizations and introduction of additional vaccines, viewing themselves as primarily responsible for vaccine promotion and patient education. The importance of educational resources for both patients and providers to maintain high levels of maternal immunization coverage was a common theme. Most identified barriers to vaccine acceptance and delivery were cultural and systematic in nature. Suggestions for improvement included improved patient and provider education, including material resources, and community engagement through religious and cultural leaders. Conclusions. The distribution of standardized, evidence-based print materials for patient education may reduce provider overwork and facilitate in-clinic efforts to inform women about maternal vaccines. Continuing education for providers should address communication surrounding current vaccines and those under consideration for introduction into routine schedules. Engagement of religious and community leaders, as well as male decision-makers in the household, will enhance future acceptance of maternal vaccines.

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Connected Diagnostics to Improve Accurate Diagnosis, Treatment, and Conditional Payment of Malaria Services in Kenya.

10.21203/rs.3.rs-36894/v1 ◽

2020 ◽

Author(s):

Shannen Van Duijn ◽

Angela Siteyi ◽

Sherzel Smith ◽

Emmanuel Milimo ◽

Leon Stijvers ◽

...

Keyword(s):

Clinical Performance ◽

Healthcare Providers ◽

Malaria Treatment ◽

Sub Saharan Africa ◽

Structured Interviews ◽

Medical Outcomes ◽

Provider Perspectives ◽

Treatment Data ◽

Sub Saharan ◽

Quantitative Statistics

Abstract Background: In sub-Saharan Africa, the material and human capacity to diagnose patients reporting with fever to healthcare providers is largely insufficient. Febrile patients are typically treated presumptively with antimalarials and/or antibiotics. Such over-prescription can lead to drug resistance and involves unnecessary costs to the health system. International funding for malaria is decreasing and transition to domestic funding is challenged by UHC efforts and recent COVID-19 outbreak. Herewith we present a digital approach to markedly improve efficiencies in diagnosis and treatment of malaria in endemic Kisumu, Kenya. The objective of this study is to evaluate feasibility, user experience, clinical performance and of Connected Diagnostics in Kisumu and to assess over-prescription of antimalarials. Methods: Our intervention was performed Oct 2017 – Dec 2018 across seven providers in Kisumu. Patients were enrolled on M-TIBA platform, diagnostic test results digitized, and only positive patients were digitally entitled for malaria treatment. Data on socio-demographics, healthcare transactions and medical outcomes were analysed using standard descriptive quantitative statistics. Provider perspectives were gathered by 19 semi-structured interviews. Results: In total 11,689 febrile patients were tested. Malaria positivity rates ranged from 7.4% to 30.2% between providers, with significantly more positive cases amongst the poor (p< 0.05). Over-prescription of antimalarials was 28%, fluctuating between 4.6% to 63.3% per provider. Prescription of branded versus generic antimalarials was dichotomous. Challenges were encountered transitioning from microscopy to RDT. Conclusion: We provide full proof-of-concept of innovative Connected Diagnostics to use digitized malaria diagnostics to earmark digital entitlements for correct malaria treatment of patients. This approach has large cost-saving and quality improving potential.

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Situations of using white lie during patient care: a qualitative study into nurses’ perspectives

10.21203/rs.2.24636/v2 ◽

2020 ◽

Author(s):

Alireza Nikbakht nasrabadi ◽

soodabeh joolaee ◽

Elham Navab ◽

Maryam esmaeilie ◽

mahboobe shali

Keyword(s):

Patient Care ◽

Professional Competence ◽

Healthcare Providers ◽

Cultural Knowledge ◽

Public Hospitals ◽

Hospital Nurses ◽

Structured Interviews ◽

Related Factors ◽

Wide Range ◽

Data Saturation

Abstract Background: Keep the patients well and fully informed about diagnosis, prognosis, and treatments is one of the patient’s rights in any healthcare system. Although all healthcare providers have the same viewpoint about rendering the truth in treatment process, sometimes the truth is not told to the patients and instead, healthcare staff use “white lie”. This study aimed to explore the nurses’ experience of white lies during patient care.Methods: This qualitative and descriptive study was conducted during June to December 2018. Eighteen hospital nurses were purposively recruited with maximum variation from ten teaching and public hospitals affiliated to Tehran University of Medical Sciences. Purposeful sampling was used and data were collected by semi-structured interviews that were continued until data saturation. Data was classified and analyzed by content analysis approach.Results: The data analysis in this study resulted in four main categories and eleven subcategories. The main categories included hope crisis, bad news, cultural diversity, and nurses’ limited professional competence. Conclusion: Results of the present study showed that, the use of white lie by nurses during patient care may be due to a wide range of patient, nurse and organizational-related factors. Communication was the main factor that influenced information rendering. Nurses’ communication with patients should be based on mutual respect, trust and adequate cultural knowledge, and also nurses should provide precise information to patients, so they can make accurate decisions regarding their health care.

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A qualitative exploration of the feasibility of incorporating depression apps into integrated primary care clinics

Translational Behavioral Medicine ◽

10.1093/tbm/ibab075 ◽

2021 ◽

Author(s):

Danae Dinkel ◽

Jennifer Harsh Caspari ◽

Louis Fok ◽

Maxine Notice ◽

David J Johnson ◽

...

Keyword(s):

Primary Care ◽

Health Management ◽

Mobile Apps ◽

Healthcare Providers ◽

Cost Effective ◽

Integrated Primary Care ◽

Healthcare Team ◽

Structured Interviews ◽

Potential Cost ◽

Share Data

Abstract The use of mobile applications or “apps” is beginning to be identified as a potential cost-effective tool for treating depression. While the use of mobile apps for health management appears promising, little is known on how to incorporate these tools into integrated primary care settings—especially from the viewpoints of patients and the clinic personnel. The purpose of this study was to explore patient- and clinic-level perceptions of the use of depression self-management apps within an integrated primary care setting. Patients (n = 17), healthcare providers, and staff (n = 15) completed focus groups or semi-structured interviews in-person or via Zoom between January and July 2020. Participants were asked about barriers and facilitators to app use, how to best integrate it into care, and reviewed pre-selected mental health apps. Data were analyzed using a directed content analysis approach. From a patient perspective, features within the app such as notifications, the provision of information, easy navigation, and a chat/support function as well as an ability to share data with their doctor were desirable. Providers and staff identified integration of app data into electronic health records to be able to share data with patients and the healthcare team as well as clear evidence of effectiveness as factors that could facilitate implementation. All participants who reviewed apps identified at least one of them they would be interested in continuing to use. Overall, patients, healthcare providers, and staff believed depression apps could be beneficial for both patients and the clinic.

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