Patient Involvement in Health Care. Different Terms Same Concept?

2019 ◽  
Vol 8 (1) ◽  
pp. 1-10
Author(s):  
Aliki Xochelli ◽  
Kostas Stamatopoulos ◽  
Christina Karamanidou
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Health Systems ◽  
Patient Participation ◽  
Chronic Conditions ◽  
Patient Involvement ◽  
Real Life ◽  
Everyday Clinical Practice ◽  
Actual Content ◽  
Potential Impact

Patient participation in health care is widely considered as crucial for the development of improved health systems and the refined management of chronic conditions. Against this background, however, there are divergent views and contradictions regarding its definition and actual content and scope. Moreover, there is no consensus as to the appropriate interventions, hence assessing their impact remains a challenge. The authors herein comment on the terms that are most commonly used for defining patient involvement in health care and underline the barriers identified in everyday clinical practice that may be responsible for failing to fully materialize its potential impact and/or endorsing it in real life.

scholarly journals Economic theory meets clinical practice: moral hazard

2019 ◽  
Vol 4 ◽  
Author(s):  
Olga Vasylyeva
Keyword(s):  
Health Care ◽  
Economic Theory ◽  
Clinical Practice ◽  
Moral Hazard ◽  
Real Life ◽  
Medical Services ◽  
Health Care Economics ◽  
Services Utilization ◽  
Field Of Vision ◽  
Concept Of Health

Economic theory must be tested by reality to prove that the goal is achievable and reproducible. However, health care economics do not always theorize based on modern-day medical practice, which results in detachment of some economic recommendations from real-life medicine. The theory of “moral hazard” assumes that patients will utilize more medical services if they transfer the risk of cost to insurances. In this article, we will revisit the understanding of appropriate avoidance of medical services and incorporate no-show rate, avoidance of care, and nonadherence into the concept of health services utilization. The primary goal of this interdisciplinary commentary is to bridge economic theory with clinical practice. It is written from the perspective of a clinical practitioner, who applies realities of everyday medicine to economic reasoning. The author hopes that this abstract will extend the field of vision of health care economics.   

Fluorescein angiography versus optical coherence tomography angiography: FA vs OCTA Italian Study

2020 ◽  
pp. 112067212090976
Author(s):  
Maria Cristina Savastano ◽  
Marco Rispoli ◽  
Bruno Lumbroso ◽  
Luca Di Antonio ◽  
Leonardo Mastropasqua ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Clinical Practice ◽  
Fluorescein Angiography ◽  
Optical Coherence Tomography Angiography ◽  
Real Life ◽  
Optical Coherence ◽  
Everyday Clinical Practice ◽  
Italian Study ◽  
Observation Period

Purpose: To assess the current role of fluorescein angiography after the introduction of optical coherence tomography angiography in real-life clinical practice. Methods: This was a multicentric retrospective observational study to evaluate the number of fluorescein angiography and optical coherence tomography angiography procedures performed by different devices from January 2013 to December 2018. The centers involved were Centro Italiano Macula (Rome), and ophthalmology departments of University “G. D’Annunzio” Chieti–Pescara (Chieti) and “Azienda Ospedaliero Universitaria Careggi” (Florence). Results: Out of 19,898 total fluorescein angiography procedures performed in the observation period, 3444 (17.3%) were in 2013, 3972 (19.9%) were in 2014, 3601 (18.1%) were in 2015, 3407 (17.2%) were in 2016, 3285 (16.5%) were in 2017, and 2189 (11%) were in 2018. Out of 7949 optical coherence tomography angiography procedures performed in the observation period, none were performed in 2013, 550 (6.9%) were in 2014, 908 (11.5%) were in 2015, 2098 (26.4%) were in 2016, 2090 (26.3%) were in 2017, and 2303 (28.9%) were in 2018. Conclusion: Fluorescein angiography procedures were performed less often after the introduction of optical coherence tomography angiography technology. The ease, speed, and safety of the optical coherence tomography angiography procedure in everyday clinical practice have facilitated more optical coherence tomography angiography application compared to fluorescein angiography in recent years. In the future, we will probably evaluate the different pathologies that still need an evaluation by fluorescein angiography.

scholarly journals Usability, Participant Acceptance, and Safety of a Prefilled Insulin Injection Device in a 3-Month Observational Survey in Everyday Clinical Practice in Australia

2009 ◽  
Vol 3 (6) ◽  
pp. 1425-1438 ◽  
Author(s):  
John Carter ◽  
Jonathan Beilin ◽  
Adam Morton ◽  
Mario De Luise
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Safety Data ◽  
Insulin Injection ◽  
Daily Basis ◽  
Injection Device ◽  
Everyday Clinical Practice ◽  
Good Safety Profile ◽  
Insulin Glulisine

Background: SoloSTAR® (SOL; sanofi-aventis, Paris, France) is a prefilled insulin pen device for the injection of insulin glargine and insulin glulisine. This is the first Australian survey to determine its usability, participant acceptance, and safety in clinical practice. Methods: A 3-month, nonrandomized, noncomparative, observational survey in Australia was conducted in individuals with diabetes. Participants were given SOL pens containing glargine, the instruction leaflet, and a toll-free helpline number. Training was offered to all participants. Safety data, including product technical complaints (PTCs), were gathered from ongoing feedback given by the participant or health care professional (HCP) and by independent interviews conducted 6–10 weeks after study start. Results: Some 2674 people consented to take part across 93 sites (150 HCPs), and 2029 participated in interviews. Of these, 52.6% had type 1 diabetes, 16.3% had manual dexterity problems, and 15.5% had poor eyesight not corrected by glasses. At the time of interview, 96.8% of participants were still using SOL. None of the eight PTCs reported were due to technical defects; most were related to handling errors. Some 62 participants reported 77 adverse events; none were related to a PTC. The vast majority of participants (95.4%) were “very satisfied” or “satisfied” with using SOL, and 89.7% of the participants had no questions or concerns using SOL on a daily basis. Similar positive findings were reported by participants with manual or dexterity impairments. Conclusions: In this survey of everyday clinical practice, SOL had a good safety profile and was very well accepted by participants.

scholarly journals Continuity of Care for Patients with Obesity-Associated Chronic Conditions: Protocol for a Multisite Retrospective Cohort Study (Preprint)

2020 ◽  
Author(s):  
Yilu Lin ◽  
James E Bailey ◽  
Satya Surbhi ◽  
Sohul A Shuvo ◽  
Christopher D Jackson ◽  
...  
Keyword(s):  
United States ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Health Outcomes ◽  
Health Systems ◽  
Continuity Of Care ◽  
Low Income ◽  
Chronic Conditions ◽  
Obesity And Diabetes

BACKGROUND Obesity affects nearly half of adults in the United States and is contributing substantially to a pandemic of obesity-associated chronic conditions such as type 2 diabetes, hypertension, and arthritis. The obesity-associated chronic condition pandemic is particularly severe in low-income, medically underserved, predominantly African-American areas in the southern United States. Little is known regarding the impact of geographic, income, and racial disparities in continuity of care on major health outcomes for patients with obesity-associated chronic conditions. OBJECTIVE The aim of this study is to assess, among patients with obesity-associated chronic conditions, and within this group, patients with type 2 diabetes, (1) whether continuity of care is associated with lower overall and potentially preventable emergency department and hospital utilization, (2) the effect of geographic, income, and racial disparities on continuity of care and on health care utilization, (3) whether continuity of care particularly protects individuals at risk for disparities from adverse health outcomes, and (4) whether characteristics of health systems are associated with higher continuity of care and better outcomes. METHODS Using 2015-2018 data from 4 practice-based research networks participating in the Southern Obesity and Diabetes Coalition, we will conduct a retrospective cohort analysis and distributed meta-analysis. Patients with obesity-associated chronic conditions and with type 2 diabetes will be assessed within each health system, following a standardized study protocol. The primary study outcomes are overall and preventable emergency department visits and hospitalizations. Continuity of care will be calculated at the facility level using a modified version of the Bice-Boxerman continuity of care index. Race will be assessed using electronic medical record data. Residence in a low-income area or a health professional shortage area respectively will be assessed by linking patient residence ZIP codes to the Centers for Medicare & Medicaid Services database. RESULTS In 4 regional health systems across Tennessee, Mississippi, Louisiana, and Arkansas, a total of 53 adult hospitals were included in the study. A total of 147,889 patients with obesity-associated chronic conditions who met study criteria were identified in these health systems, of which 45,453 patients met the type 2 diabetes criteria for inclusion. Results are expected by the end of 2020. CONCLUSIONS This study should reveal whether health system efforts to increase continuity of care for patients with obesity and diabetes have potential to improve outcomes and reduce costs. Analyzing disparities in continuity of care and their effect on major health outcomes can help demonstrate how to improve care and use of health care resources for vulnerable patients with obesity-associated chronic conditions, and within this group, patients with type 2 diabetes. Better understanding of the association between continuity and health care utilization for these vulnerable populations will contribute to the development of higher-value health systems in the southern United States. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/20788

scholarly journals Continuity of Care for Patients with Obesity-Associated Chronic Conditions: Protocol for a Multisite Retrospective Cohort Study

10.2196/20788 ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. e20788
Author(s):  
Yilu Lin ◽  
James E Bailey ◽  
Satya Surbhi ◽  
Sohul A Shuvo ◽  
Christopher D Jackson ◽  
...  
Keyword(s):  
United States ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Health Outcomes ◽  
Health Systems ◽  
Continuity Of Care ◽  
Low Income ◽  
Chronic Conditions ◽  
Obesity And Diabetes

Background Obesity affects nearly half of adults in the United States and is contributing substantially to a pandemic of obesity-associated chronic conditions such as type 2 diabetes, hypertension, and arthritis. The obesity-associated chronic condition pandemic is particularly severe in low-income, medically underserved, predominantly African-American areas in the southern United States. Little is known regarding the impact of geographic, income, and racial disparities in continuity of care on major health outcomes for patients with obesity-associated chronic conditions. Objective The aim of this study is to assess, among patients with obesity-associated chronic conditions, and within this group, patients with type 2 diabetes, (1) whether continuity of care is associated with lower overall and potentially preventable emergency department and hospital utilization, (2) the effect of geographic, income, and racial disparities on continuity of care and on health care utilization, (3) whether continuity of care particularly protects individuals at risk for disparities from adverse health outcomes, and (4) whether characteristics of health systems are associated with higher continuity of care and better outcomes. Methods Using 2015-2018 data from 4 practice-based research networks participating in the Southern Obesity and Diabetes Coalition, we will conduct a retrospective cohort analysis and distributed meta-analysis. Patients with obesity-associated chronic conditions and with type 2 diabetes will be assessed within each health system, following a standardized study protocol. The primary study outcomes are overall and preventable emergency department visits and hospitalizations. Continuity of care will be calculated at the facility level using a modified version of the Bice-Boxerman continuity of care index. Race will be assessed using electronic medical record data. Residence in a low-income area or a health professional shortage area respectively will be assessed by linking patient residence ZIP codes to the Centers for Medicare & Medicaid Services database. Results In 4 regional health systems across Tennessee, Mississippi, Louisiana, and Arkansas, a total of 53 adult hospitals were included in the study. A total of 147,889 patients with obesity-associated chronic conditions who met study criteria were identified in these health systems, of which 45,453 patients met the type 2 diabetes criteria for inclusion. Results are expected by the end of 2020. Conclusions This study should reveal whether health system efforts to increase continuity of care for patients with obesity and diabetes have potential to improve outcomes and reduce costs. Analyzing disparities in continuity of care and their effect on major health outcomes can help demonstrate how to improve care and use of health care resources for vulnerable patients with obesity-associated chronic conditions, and within this group, patients with type 2 diabetes. Better understanding of the association between continuity and health care utilization for these vulnerable populations will contribute to the development of higher-value health systems in the southern United States. International Registered Report Identifier (IRRID) DERR1-10.2196/20788

scholarly journals Role of Artificial Intelligence Applications in Real-Life Clinical Practice: Systematic Review (Preprint)

2020 ◽  
Author(s):  
Jiamin Yin ◽  
Kee Yuan Ngiam ◽  
Hock Hai Teo
Keyword(s):  
Artificial Intelligence ◽  
Health Care ◽  
Clinical Practice ◽  
Risk Analysis ◽  
Early Stage ◽  
Controlled Trial ◽  
Real Life ◽  
Disease Diagnosis ◽  
Clinical Settings ◽  
Clinical Implementation

BACKGROUND Artificial intelligence (AI) applications are growing at an unprecedented pace in health care, including disease diagnosis, triage or screening, risk analysis, surgical operations, and so forth. Despite a great deal of research in the development and validation of health care AI, only few applications have been actually implemented at the frontlines of clinical practice. OBJECTIVE The objective of this study was to systematically review AI applications that have been implemented in real-life clinical practice. METHODS We conducted a literature search in PubMed, Embase, Cochrane Central, and CINAHL to identify relevant articles published between January 2010 and May 2020. We also hand searched premier computer science journals and conferences as well as registered clinical trials. Studies were included if they reported AI applications that had been implemented in real-world clinical settings. RESULTS We identified 51 relevant studies that reported the implementation and evaluation of AI applications in clinical practice, of which 13 adopted a randomized controlled trial design and eight adopted an experimental design. The AI applications targeted various clinical tasks, such as screening or triage (n=16), disease diagnosis (n=16), risk analysis (n=14), and treatment (n=7). The most commonly addressed diseases and conditions were sepsis (n=6), breast cancer (n=5), diabetic retinopathy (n=4), and polyp and adenoma (n=4). Regarding the evaluation outcomes, we found that 26 studies examined the performance of AI applications in clinical settings, 33 studies examined the effect of AI applications on clinician outcomes, 14 studies examined the effect on patient outcomes, and one study examined the economic impact associated with AI implementation. CONCLUSIONS This review indicates that research on the clinical implementation of AI applications is still at an early stage despite the great potential. More research needs to assess the benefits and challenges associated with clinical AI applications through a more rigorous methodology.

Professionals’ embodied orientations towards patients in discharge-planning meetings and their impact on patient participation

2017 ◽  
Vol 13 (1) ◽  
Author(s):  
Sara Keel ◽  
Veronika Schoeb
Keyword(s):  
Clinical Practice ◽  
Patient Participation ◽  
Clinical Guidelines ◽  
Healthcare Professionals ◽  
Discharge Planning ◽  
Everyday Clinical Practice ◽  
Rehabilitation Process ◽  
Activity Structure ◽  
German Speaking ◽  
Rehabilitation Clinic

To enhance the patient’s involvement, clinical guidelines on rehabilitation require the patient’s participation in the entire rehabilitation process, including discharge planning (DP). However, very little is known about how this institutional demand is actually dealt with in everyday clinical practice. Adopting a conversation analytic (CA) approach, our paper tackles the matter by looking at interdisciplinary entry meetings (IEMs) at a rehabilitation clinic in German-speaking Switzerland. Our study is based on audio-visual recordings of 11 IEMs, whose central aim is to formulate patients’ rehabilitation goals and to plan their discharge. The paper offers a detailed analysis of the embodied practices through which healthcare professionals seek to involve patients in the IEMs, and also investigates patients’ responses. Our analysis shows that, although carefully elaborated, the professionals’ practices do not elicit more than reactive patient participation. The paper argues that this is due to (1) the practices’ temporal positioning within the overall activity structure of the meeting – they are deployed when no important decision is at stake, projecting minimal patient participation on the phases in which decisions are taken – and (2) the actions the practices project on the next turn: confirmation, acknowledgement or ratification of what has previously been proposed by professionals.

Evidence-Based Occupational Therapy

1998 ◽  
Vol 65 (3) ◽  
pp. 131-135 ◽  
Author(s):  
Mary Law ◽  
Carolyn Baum
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Occupational Therapy ◽  
Real Life ◽  
Evidence Based ◽  
Clinical Decisions ◽  
Evidence Based Health Care

“Is evidence-based health care just a passing fad, promoted by managers and purchasers enjoying their influence over clinical practice, but doomed to fail as a far too cumbersome method for dealing with the complexity and imprecision of real-life clinical decisions? ”

scholarly journals Role of Artificial Intelligence Applications in Real-Life Clinical Practice: Systematic Review

10.2196/25759 ◽  
2021 ◽  
Vol 23 (4) ◽  
pp. e25759
Author(s):  
Jiamin Yin ◽  
Kee Yuan Ngiam ◽  
Hock Hai Teo
Keyword(s):  
Artificial Intelligence ◽  
Health Care ◽  
Clinical Practice ◽  
Risk Analysis ◽  
Early Stage ◽  
Controlled Trial ◽  
Real Life ◽  
Disease Diagnosis ◽  
Clinical Settings ◽  
Clinical Implementation

Background Artificial intelligence (AI) applications are growing at an unprecedented pace in health care, including disease diagnosis, triage or screening, risk analysis, surgical operations, and so forth. Despite a great deal of research in the development and validation of health care AI, only few applications have been actually implemented at the frontlines of clinical practice. Objective The objective of this study was to systematically review AI applications that have been implemented in real-life clinical practice. Methods We conducted a literature search in PubMed, Embase, Cochrane Central, and CINAHL to identify relevant articles published between January 2010 and May 2020. We also hand searched premier computer science journals and conferences as well as registered clinical trials. Studies were included if they reported AI applications that had been implemented in real-world clinical settings. Results We identified 51 relevant studies that reported the implementation and evaluation of AI applications in clinical practice, of which 13 adopted a randomized controlled trial design and eight adopted an experimental design. The AI applications targeted various clinical tasks, such as screening or triage (n=16), disease diagnosis (n=16), risk analysis (n=14), and treatment (n=7). The most commonly addressed diseases and conditions were sepsis (n=6), breast cancer (n=5), diabetic retinopathy (n=4), and polyp and adenoma (n=4). Regarding the evaluation outcomes, we found that 26 studies examined the performance of AI applications in clinical settings, 33 studies examined the effect of AI applications on clinician outcomes, 14 studies examined the effect on patient outcomes, and one study examined the economic impact associated with AI implementation. Conclusions This review indicates that research on the clinical implementation of AI applications is still at an early stage despite the great potential. More research needs to assess the benefits and challenges associated with clinical AI applications through a more rigorous methodology.

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