PARTNER-MH, a Peer-Led Patient Navigation Intervention for Racial and Ethnic Minority Veterans in Veterans Health Administration (VHA) Mental Health Services: A Mixed-Methods Randomized Controlled Feasibility Trial Study Protocol

Background: Mental healthcare disparities are persistent and have increased in recent years. Compared to their White counterparts, racial and ethnic minority groups have less access to mental healthcare. Minority groups also have lower engagement in mental health treatment and are more likely to experience ineffective patient-provider communication, which contribute to negative mental healthcare experiences and poor mental health outcomes. Interventions that embrace recovery-oriented practices to support patient engagement and empower patients to participate in their mental healthcare and treatment decisions may help to reduce mental healthcare disparities. Designed to achieve this goal, PARTNER-MH is a peer-led, patient navigation intervention that aims to engage minority patients in mental health treatment, support them to take a greater role in their care, and facilitate their participation in treatment shared decision-making. Methods: This pilot study evaluates the feasibility and acceptability of PARTNER-MH in a VHA mental health setting using a mixed-methods, randomized controlled trial study design. PARTNER-MH is tested under real-world conditions, using certified VHA peer support specialists (peers), selected via usual VHA hiring practices and assigned to the mental health service. The peers provide PARTNER-MH and usual peer support services. The study compares the impact of PARTNER-MH versus a wait-list control group on patient activation, patient engagement, and shared decision-making, as well as other patient-level outcomes. PARTNER-MH also examines organizational factors that could impact its future implementation in VHA settings. Results: Participants (N=50) were veterans who were mostly male (62%), self-identified as non-Hispanic Black (70%), with a median age in the 45-54 group. Most had at least some college education, and 32% completed 4 or more years of college. Randomization produced comparable groups in terms of characteristics and outcome measures at baseline, except for gender. Discussion and Conclusion: Rather than simply documenting health disparities among vulnerable populations, PARTNER-MH offers opportunities to evaluate a tailored, culturally-sensitive system-based intervention to improve patient engagement and patient-provider communication in mental healthcare for racial and ethnic minorities. IRB Protocol #1708628270Trial registration: ClinicalTrials.gov, NCT04515771. Registered 14 August 2020, https://clinicaltrials.gov/ct2/show/NCT04515771

Disparity on Online Patient-Provider Communication and Implications for a Post-COVID Era

Online patient-provider communication (OPPC) increases access to health-related information, enhances self-care, and reduces healthcare expenditures. We investigated OPPC and technology use changes during 6 years. This descriptive cohort analysis involved data collected from the National Health and Aging Trends Study (NHATS) between 2011-2016 and during the pandemic (2020). NHATS consist of a nationally representative sample of Medicare beneficiaries. From a total of N=2,389, we assigned cohorts as those who: (1) own computers (High-Tech, 56.1%), (2) own cell phone only or don’t own computer nor cell phones (Low-Tech, 20.2%), and (3) just adopted cell phone or computers (Transition, 23.7%). Only the High-Tech users increased OPPC by 75% over 2011-2016; others remained the same. During the pandemic more participants used mobile technology and internet. Newly adopting technology on its own does not automatically increase OPPC. It is important for Transition users to access training and support to benefit from OPPC.

Healthcare Providers’ Perspectives and Role in Improving Patient Engagement in HIV Treatment and Care in Almaty, Kazakhstan

The HIV epidemic continues to grow in Eastern Europe and Central Asia. At the same time, there are major gaps in engagement in HIV treatment and care among people living with HIV (PLHIV) in the region, including Kazakhstan. Healthcare providers may have the potential to improve patients’ initiation of and adherence to HIV treatment; however, their perspectives and experiences are often overlooked in the research from Kazakhstan. The purpose of our study was to gain an in-depth understanding of how providers perceive the factors influencing PLHIV’s engagement in HIV treatment and care and to identify opportunities for expanding the role that providers can have in improving patient initiation and adherence to treatment in Kazakhstan. Through purposive sampling, we conducted in-depth interviews with 14 healthcare providers at the City AIDS Center in Almaty. We used team-based coding and thematic analysis in order to analyze the data. Quotes from providers were translated from Kazakh and Russian to English to illustrate the themes. Our results show that providers currently view their role as the need to break down myths around ART medications, and to educate and motivate patients to accept their diagnosis and learn to live with HIV. The need to address stigma and social isolation among PLHIV, the risk of overworked providers, and the need to improve patient-provider communication strategies are areas to consider for further interventions. Patient-provider communication interventions are needed in Kazakhstan in order to help meet the country’s 90-90-90 HIV targets.

A Digital Patient–Provider Communication Intervention to Support Shared Decision Making in Chronic Health Care, InvolveMe: Feasibility Pilot Study (Preprint)

BACKGROUND Living with a chronic health condition is demanding and comes with symptoms that may negatively affect health related quality of life (HRQoL). Management of chronic conditions often requires communication and interaction with health care providers (HCP), and good communication can improve symptom management as well as HRQoL. However, experiences of poor communication and interaction between patients and HCPs are common. Digital patient-provider communication interventions carry the potential to facilitate shared decision making (SDM) through improved communication and interaction. The InvolveMe intervention was therefore designed to provide patients with the opportunity to communicate symptoms and informational needs, and to prioritize preferences for care prior to outpatient visits at the hospital, as well as to interact with HCPs through secure messages in-between outpatient visits. OBJECTIVE This study aimed to assess feasibility of the InvolveMe intervention (ie, use of a digital assessment prior to hospital visits and use of secure messages in-between visits) by investigating system acceptability and demand (ie, system use), explore potential impact on patient reported outcome measures, and use study findings to tailor the intervention and study routines to prepare for future implementation in a clinical trial. METHODS The study was designed as a pre-post feasibility study. Patients from one outpatient clinic were invited to use the InvolveMe intervention for 3 months. Feasibility was tested by exploring: (1) acceptability; data collected from non-participants and participants during recruitment, and the System Usability Scale (SUS), (2) demand; exploration of system use through extraction of system log data, (3) limited efficacy testing; exploration of potential effects from the Short-Form Health Survey (RAND 36), the Hospital Anxiety and Depression Scale and the Health Literacy Questionnaire, and (4) implementation preparation; using collected data to tailor the intervention and study routines. RESULTS Participants (N=23) were median 54 (range 26-78) years old and primarily male (61%, 14/23). All participants completed outcome measures at baseline, and 19 completed outcome measures at 3 months. Average SUS score was 72.2, indicating good system usability. Eight participants completed assessments from home prior to hospital visit. The assessments entailed various bodily symptoms and needs for information. Participants sent 17 secure messages related to patient administrative matters, symptoms and challenges. Preliminary outcome measure findings at 3 months were mixed. Results contributed to ideas for tailoring of the InvolveMe intervention as well as tailoring of study routines. CONCLUSIONS Findings allowed establishing feasibility for the InvolveMe intervention and informed intervention tailoring in preparation of a future clinical trial. Given that participants used the secure assessment and messages to communicate about bodily symptoms, needs for information and challenges experienced, use of InvolveMe may have the potential to facilitate SDM through enhancing accessibility, information exchange and strengthen patient-HCP relationship for patients living with chronic health conditions. CLINICALTRIAL ClinicalTrials.gov NCT NCT04218721

Disclosure of conventional and complementary medicine use to medical doctors and complementary medicine practitioners: A survey of rates and reasons amongst those with chronic conditions

Chronic conditions are prolonged and complex, leading patients to seek multiple forms of care alongside conventional treatment, including complementary medicine (CM). These multiple forms of care are often used concomitantly, requiring patient-provider communication about treatments used in order to manage potential risks. In response, this study describes rates and reasons for disclosure/non-disclosure of conventional medicine use to CM practitioners, and CM use to medical doctors, by individuals with chronic conditions. A survey was conducted online in July and August 2017 amongst the Australian adult population. Participants with chronic conditions were asked about their disclosure-related communication with CM practitioners (massage therapist, chiropractor, acupuncturist, naturopath) and medical doctors. Patients consulting different professions reported varying disclosure rates and reasons. Full disclosure (disclosed ALL) to medical doctors was higher (62.7%-79.5%) than full disclosure to CM practitioners (41.2%-56.9%). The most strongly reported reason for disclosing to both MDs and CM practitioners was I wanted them to fully understand my health status, while for non-disclosure it was They did not ask me about my CM/medicine use. Reasons regarding concerns or expectations around the consultation or patient-provider relationship were also influential. The findings suggest that patient disclosure of treatment use in clinical consultation for chronic conditions may be improved through patient education about its importance, direct provider inquiry, and supportive patient-provider partnerships. Provision of optimal patient care for those with chronic conditions requires greater attention to patient-provider communication surrounding patients’ wider care and treatment use.

Information needs and experiences from pregnancies complicated by hypertensive disorders: a qualitative analysis of narrative responses

Background Incorporation of the patient voice is urgently needed in a broad array of health care settings, but it is particularly lacking in the obstetrical literature. Systematically derived information about patients’ experience with hypertensive disorders of pregnancy (HDP), most notably preeclampsia, is necessary to improve patient-provider communication and ultimately inform patient-centered care and research. We sought to examine the information needs and experiences of individuals with pregnancies complicated by hypertensive disorders. Methods We conducted a qualitative content analysis of narrative-responses to an open-ended question from the Preeclampsia Registry (TPR), an online registry hosted by the Preeclampsia Foundation. Individuals were invited to enroll in TPR via social media, web searches, and newsletters. We restricted our analysis to participants who self-reported a history of HDP and responded to the open-ended question, “Is there any information that you could have had at the time of this pregnancy that would have been helpful?”. Available responses from July 2013 to March 2017 were included. Narrative responses were coded, reconciled, and thematically analyzed by multiple coders using an inductive approach. Our main outcome measures included participants’ expressed needs and additional concerns with respect to their HDP pregnancy. Results Of 3202 enrolled participants, 1850 completed the survey and self-reported having at least one pregnancy complicated by HDP, of which 895 (48.4%) responded to the open-ended question. Participants delivered in the United States (83%) and 27 other countries. Compared to non-responders, responders reported more severe HDP phenotypes and adverse offspring outcomes. We identified three principal themes from responses: patient-identified needs, management and counseling, and potential action. Responses revealed that participants’ baseline understanding of HDP, including symptoms, management, therapeutic strategies, and postpartum complications, was demonstrably lacking. Responders strongly desired improved counseling so that both they and their providers could collaboratively diagnose, appropriately manage, and robustly and continuously communicate to facilitate a partnership to address any HDP complications. Conclusions Participants’ responses regarding their HDP experience provide indispensable insight into the patient’s perspectives. Our study suggests that improved education regarding possible HDP complications and transparency about the consideration of HDP and its associated outcomes during an evaluation are needed, and efforts to implement these strategies should be sought. Trial registration The Preeclampsia Registry: NCT02020174