Shifts in allergy practice in a COVID-19 world: Implications of pre–COVID-19 national health care provider and patient surveys of treatments for nasal allergies

2021 ◽  
Author(s):  
Tonya Winders ◽  
Lawrence DuBuske ◽  
Don A. Bukstein ◽  
Eli O. Meltzer ◽  
Dana Wallace ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Nasal Allergy ◽  
Shared Decision ◽  
Care Providers ◽  
Provider Surveys

Background: Most U.S. patient and health care provider surveys with regard to nasal allergy treatments were conducted before sublingual immunotherapy (SLIT)-tablets and allergy immunotherapy (AIT) shared decision-making tools were available.Objective: Patient and health care provider surveys with regard to current perceptions of nasal allergy burden, symptoms, and treatments were conducted to compare with previous surveys and provide insight into the use of SLIT-tablets and AIT shared decision-making tools.Methods: From November-December 2019, adults (N = 510) diagnosed with nasal allergies and health care providers (N = 304) who treated nasal allergies in the United States completed surveys with regard to nasal allergy management.Results: Of the patient respondents, 42% reported that their symptoms were only somewhat controlled and 48% had avoided activities because of their nasal allergies. In all, 38% were using only over-the-counter (OTC) medications for treatment, and 42%, 7%, and 8% had ever received subcutaneous immunotherapy (SCIT), sublingual allergy drops, or SLIT-tablets, respectively; 56% and 85% reported that they had never discussed SCIT or SLIT, respectively, with their health care provider. Of the health care provider respondents, 45%, 58%, and 20% were very likely to discuss OTC medications, SCIT, or SLIT, respectively. Allergists were more inclined to discuss SCIT with their patients than other health care providers (82% versus 33%, respectively). Most allergists (67%) and other health care providers (62%) reported that they did not use an AIT shared decision-making tool, primarily because of unawareness.Conclusion: The patients with nasal allergies continued to report inadequate symptom control and activity impairment.SLIT-tablets and AIT shared decision-making tools were underused. In the coronavirus disease 2019 era, social distancing may limit office visits, which impacts SCIT administration and prompts increased use of telemedicine and a possible advantage for at-home–administered SLIT-tablets over SCIT.

scholarly journals Shared decision-making in food allergy management

2020 ◽  
Vol 2 (1) ◽  
pp. 124-127
Author(s):  
Meera Patrawala ◽  
Gerald Lee ◽  
Brian Vickery
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Food Allergy ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Decision Aids ◽  
Shared Decision ◽  
Care Providers ◽  
Patient Centered ◽  
Evidenced Based

Historically, the role of the health-care provider in medical practice has been primarily paternalistic by offering information, compassion, and decisive views with regard to medical decisions. This approach would exclude patients in the decision-making process. In a shift toward more patient-centered care, health-care providers are routinely encouraged to practice shared decision making (SDM). SDM uses evidence-based information about the options, elicitation of patient preferences, and decision support based on the patient’s needs with the use of decision aids or counseling. Although there are well-known benefits of SDM, including improvements in psychological, clinical, and health-care system domains providers have found it challenging to apply SDM in everyday clinical practice. In allergy, we have a unique role in the treatment of children and adults, and SDM should be applied appropriately when engaging with these specific groups. There are many situations in which there is not a clear best option (food allergy testing, food introduction and challenges, and immunotherapy). Therefore, decision aids specific to our field, coupled with evidenced-based information that ultimately leads to a decision that reflects the patient’s values will make for a vital skill in practice. In this article, we defined SDM, the benefits and barriers to SDM, unique situations in SDM, and approach to SDM in food allergy.

scholarly journals Shared Decision-making between health care providers and patients at a Tertiary Hospital Diabetic Clinic in Tanzania

2020 ◽  
Author(s):  
Oswald Vedasto ◽  
Baraka Morris ◽  
Francis Fredrick Furia
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Shared Decision ◽  
Care Providers ◽  
Muhimbili National Hospital ◽  
National Hospital ◽  
Diabetic Clinic ◽  
Participation In Decision Making

Abstract Background Patients’ participation in decision making regarding their treatment play an important role in treatment outcome through improvement in self-care and adherence to treatment. There is scarcity of information regarding shared decision making in sub-Saharan Africa. This study was conducted to assess participation of patients and health care providers in decision-making process in the diabetic clinic at Muhimbili National Hospital, Dar es Salaam, Tanzania.Methods This study employed a phenomenological study design using in-depth interview technique. Study participants were diabetic patients visiting the clinic and healthcare providers working in the diabetic clinic at Muhimbili National Hospital. Data was collected using interview guide with open ended questions using an audio digital recorder. Content analysis method was used during analysis whereby categories were reached through the process of coding with assistance by Nvivo 12 software. Results Several themes were identified in this study including some form of participation in decision making of patients, use of decision aids in the clinic and belief and values regarding patients’ engagement in decision making. Several factors were identified as barriers to shared decision making as noted from participants interview, these included lack of time, literacy level, beliefs and values. Decision aids were reported to be important for improving patient’s knowledge and subsequently their involvement in decisions that were made although it was also noted that these were not prepared by the health care providers in the clinic and they were not adequately provided.Conclusion Some form of participation in decision making was observed in the diabetic clinic at Muhimbili national Hospital, and barriers identified for shared decision-making included time, literacy, beliefs and values.

Listening to Haitian Women and their Health Care Providers: Insight into Shared Decision-making After Cesarean Section

2021 ◽  
Vol 32 (2) ◽  
pp. 931-947
Author(s):  
Somphit Chinkam ◽  
Kathryn Mezwa ◽  
Kimberly Ashley Pierre ◽  
Courtney Steer-Massaro ◽  
Ivan Herbey ◽  
...  
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Cesarean Section ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Shared Decision ◽  
Care Providers ◽  
Haitian Women ◽  
Insight Into

scholarly journals Shared Decision-making between health care providers and patients at a Tertiary Hospital Diabetic Clinic in Tanzania

2020 ◽  
Author(s):  
Osward Vedasto ◽  
Baraka Morris ◽  
Francis Fredrick Furia
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Health Care Providers ◽  
Healthcare Providers ◽  
Shared Decision ◽  
Care Providers ◽  
Muhimbili National Hospital ◽  
National Hospital ◽  
Patient Beliefs

Abstract Background Patients’ participation in decision making regarding their treatment is defined in ethical, legal and human rights standards in the provision of care that concerns health providers and the entire community. This study was conducted to document experiences of patients and health care providers on shared decision making. Methods:This study employed a phenomenological study design using in-depth interview technique. Study participants were diabetic patients visiting the clinic and healthcare providers working at Muhimbili National Hospital. Data was collected using the semi-structured interview guide with open-ended questions using an audio digital recorder. Content analysis method was used during analysis whereby categories were reached through the process of coding assisted by Nvivo 12 software. Results Participants in this study expressed the role of shared decision-making in the care of patients with diabetes, with report of engagement of patients by health care providers in making treatment decisions. Participants reported no use of decision-making aids; however, health education tools were reported by participants to be used for educating patients. Limited time, patient beliefs and literacy were documented as barriers of effective engagement of patients in decision making by their healthcare providers. Conclusion Engagement of patients in decision-making was noted in this study as experienced by participants of this study. Time, patient beliefs and patient literacy were documented as barriers for patients engagement, therefore diabetic clinic at Muhimbili National Hospital need to devise mechanisms for ensuring patients involvement in treatment decisions.

scholarly journals Implementation of shared decision-making for aortic stenosis: Development of a patient decision aid

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
S Lauck ◽  
B Borregaard ◽  
K Lewis ◽  
I De Souza
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Shared Decision Making ◽  
Valve Replacement ◽  
Health Care Providers ◽  
Shared Decision ◽  
Care Providers ◽  
Patient Decision

Abstract Funding Acknowledgements Type of funding sources: None. Background  People living with aortic stenosis (AS) experience poor quality of life (QOL), repeat hospitalizations, and a poor prognosis in the absence of valve replacement. There is increasing equipoise in the evidence supporting the use of surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) in patients likely to derive survival and QOL benefit. A transition to a palliative approach may be a better option in the setting of excessive frailty and comorbid burden. Shared decision-making (SDM) is a bidirectional exchange between patients and health care providers that enables an information exchange about the best available evidence and decisions that consider patients" priorities. The goal is to inform and empower patients to participate in choosing the right decision. Patient decision aids (PDAs) are designed to support the process of SDM and help guide these conversation. To date, Canadians living with AS have not had access to a validated PDA.  Study Design   We will report on the design of the SharEd DEcision-MaKing for AS (SEEK-AS) study that aims to refine and comprehensively evaluate a set of PDAs and to build capacity for SDM through a unique partnership of patient and clinical knowledge users, multidisciplinary health care providers and researchers, and policy-makers. We will summarize the pilot work completed to obtain a debrief of patient resources used in all Canadian provinces, the draft development of a PDA in concert with a health policy initiative, and the design of an electronic platform to individualize risk in real time during a consultation. We will outline the components of SEEK-AS and the use of a cross-provincial comparative case study design to investigate how to establish an effective and sustainable approach for the implementation of the PDAs using the Knowledge-to-Action conceptual framework.  Implications  There is a pressing need for the development of evidence-based tools to strengthen the integration of patients" perspectives in the treatment of complex valvular heart disease given the rapid pace of change in technology, indications and practice. The study of the implementation of innovative strategies to achieve this goal is essential to accelerate the pace of change in clinical care.

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