What do patients experience? Interprofessional collaborative practice for chronic conditions in primary care: an integrative review

Background Improving the patient experience is one of the quadruple aims of healthcare. Therefore, understanding patient experiences and perceptions of healthcare interactions is paramount to quality improvement. This integrative review aimed to explore how patients with chronic conditions experience Interprofessional Collaborative Practice in primary care. Methods An integrative review was conducted to comprehensively synthesize primary studies that used qualitative, quantitative, and mixed methods. Databases searched were Medline, Embase, CINAHL and Web of Science on June 1st, 2021. Eligible studies were empirical full-text studies in primary care that reported experiences or perceptions of Interprofessional Collaborative Practice by adult patients with a chronic condition, in any language published in any year. Quality appraisal was conducted on included studies using the Mixed Method Appraisal Tool. Data on patients’ experiences and perceptions of Interprofessional Collaborative Practice in primary care were extracted, and findings were thematically analyzed through a meta-synthesis. Results Forty-eight (n = 48) studies met the inclusion criteria with a total of n = 3803 participants. Study quality of individual studies was limited by study design, incomplete reporting, and the potential for positive publication bias. Three themes and their sub-themes were developed inductively: (1) Interacting with Healthcare Teams, subthemes: widening the network, connecting with professionals, looking beyond the condition, and overcoming chronic condition collectively; (2) Valuing Convenient Healthcare, subthemes: sharing space and time, care planning creates structure, coordinating care, valuing the general practitioner role, and affording healthcare; (3) Engaging Self-care, subthemes: engaging passively is circumstantial, and, engaging actively and leading care. Conclusions Patients overwhelmingly had positive experiences of Interprofessional Collaborative Practice, signaling it is appropriate for chronic condition management in primary care. The patient role in managing their chronic condition was closely linked to their experience. Future studies should investigate how the patient role impacts the experience of patients, carers, and health professionals in this context. Systematic review registration PROSPERO: CRD42020156536.

Left Ventricular Myocardial Noncompaction with Advanced Atrioventricular Conduction Disorder and Ventricular Arrhythmias in a Young Patient: Role of MIB1 Gene

Left ventricular noncompaction (LVNC) is a structural abnormality of the left ventricle, usually described as an isolated condition, or sometimes associated with other structural cardiac diseases. LVNC is generally asymptomatic, although it may present conduction disorders, arrhythmias, and heart failure. Here, we present the case of a patient who came to our attention with a severe LVNC phenotype associated with advanced AV conduction disorder, and supraventricular and ventricular arrhythmias at young age, in which a novel MIB1, likely pathogenic, variation has been identified.

Exploring power shifts as an enabler for a strengthened patient role in quality improvements: a Swedish survey study

ObjectivesThis study examined the relationship between professionals’ perceptions of a strengthened role for the patient and of patient involvement in quality improvement (QI) and whether professionals’ experiences in improvement science were a moderator on such a relationship.DesignFrom a predominantly close-ended, 44-item questionnaire, 4 questions specifically concerning professionals′ perception on patient involvement in QI were analysed.SettingThree Swedish regions.Participants155 healthcare professionals who had previously participated in courses in improvement science.ResultsThe covariate patient involvement was significantly related to a perceived strengthened patient role. There was also a significant interaction effect between degree of patient involvement and professionals’ experience in the area of improvement science on a strengthened patient role. The result shows that there is a relationship between the perceived level of patient involvement in improvements and professionals’ perceptions of a strengthened patient role. In this study, the covariate, perceived patient involvement, was significantly related to experiences of more equal relationships between patients and healthcare professionals. There was also a significant interaction effect between the degree of patient involvement and professionals’ experience in the area of improvement science, for a more equal relationship between patients and healthcare professionals.ConclusionIncreased patient involvement in QI is a means of strengthening the patient role and supporting a more equal relation between patients and healthcare professionals. Furthermore, empirical evidence shows that the healthcare professionals’ experiences in the area of improvement science support a strengthened patient role and a more equal power relationship, but for this to happen, the mindset of professionals is key. Future research is needed to capture and investigate the experiences from patients and relatives about being involved in QI in healthcare, and to study the effects on quality in care processes.

Physiotherapy students can be educated to portray realistic patient roles in simulation: a pragmatic observational study

Background Simulation-based education (SBE) has many benefits for learners, but costs can limit embedding SBE in health professional curricula. Peer simulation involves students portraying patient roles, and may reduce costs while still providing the benefits of other SBE experiences. However, the quality of the SBE may be impacted if students cannot portray authentic and realistic patient roles. The aim of this study was to investigate whether targeted education was associated with observable changes to physiotherapy students’ abilities to portray patient roles in SBE. Methods Second year pre-registration physiotherapy students (n = 40) participated. Students completed online and face-to-face education about SBE, patient portrayal skills, and how to portray a specific patient role. Students were video-recorded portraying patient roles in practical exams before and after the program. Three blinded independent assessors rated the overall quality of portrayals using a purpose-developed assessment instrument. Results Twenty-three sets of pre- and post-program videos were analysed. Correlations between assessor scores spanned 0.62 to 0.82 for analyses of interest, which justified using average assessor ratings in analysis. Statistically significant higher scores were seen for post-program assessments for overall portrayal scores (mean difference 6.5, 95%CI [1.51–11.45], p = 0.013), accuracy (mean difference 3.4, 95%CI [0.69–6.13], p = 0.016) and quality (mean difference 3.1, 95%CI [0.64–5.49], p = 0.016). Conclusions Physiotherapy students appear capable of playing realistic patient roles. Peer simulation can be embedded into health professional programs, and education in patient role portrayal appears to be associated with improvements in portrayal quality and realism. Given these findings, further investigation, including testing program effects in a randomised study, is warranted.

Treatment

This chapter describes the narrative medicine methodology of this project, comprising three pillars. First is interdisciplinarity, bridging clinical and scientific research; history of science and medicine; literature and film; literary criticism and theory; and philosophy, among others. The use of rhetoric in such discourses is discussed, as well as the opportunity for meaningful critique in truly transdisciplinary work. Second is narrative attentiveness toward creative and clinical texts, illuminating and critiquing their rhetorical forms and effects. Third is the creation of a challenging writerly text—in this case, in moving between different roles, such as that of diagnostician, patient, critic—and highlighting the author’s own embodied experience, inviting the reader’s active involvement. This orientation shifts the narrative medicine emphasis on the clinician as reader/listener/interpreter to a mutually participatory engagement in which those in the patient role are understood as writerly readers. Finally, the figure of blindsight as a “prescription” for metagnosis is introduced.

‘Spending the day with your Family Health Team’: rapid ethnography of a patient-centred quality improvement event

BackgroundPrimary care practices have started to explore different methods of engaging with patients to advance quality improvement. This approach leverages the strengths of citizen engagement; however, there has been a lack of empirical research to understand the impact of such an approach from the patient perspective.AimTo understand how citizen engagement can inform quality improvement in family practice.Design & settingA single-centre, rapid ethnographic evaluation of a patient engagement event.MethodTen thousand email invitations were sent and posters put up in Family Health Team (FHT) waiting rooms, resulting in 350 patient responses and the purposive recruitment of 36 participants. Observation and key informant interviews were used to collect data. The data corpus was analysed according to ethnographically-informed thematic analysis techniques.ResultsAnalysis of the full set of field notes, patient interviews, and informal conversations with the FHT staff revealed three factors that impacted on the success of the patient engagement event: setting the stage, the power of storytelling, and the value of reframing the patient role.ConclusionThe present study highlights three components of patient and public engagement approaches — the importance of setting the proper stage, storytelling as a tool, and reframing the patient role in healthcare delivery — which may provide useful guidance to those considering similar patient and public engagement events.