A Survey of Patients’ Opinions and Preferences on the Use of E-Prescriptions in Poland

E-prescription is already used in many countries, improving the standard of patient care. Officially, from 8 January 2020 e-prescribing has been obligated in Poland. Physicians’ and pharmacists’ opinions on e-prescribing have been widely researched and reported in the literature. In contrast, patients’ perception has, to date, received little attention. For this reason, the aim of this study was to find the features and functionalities of e-prescribing that are desired by the public and influence the positive evaluation of this tool, according to patient opinion. In order to obtain data, a questionnaire was completed by 456 randomly selected adults. The obtained results indicated that only eight people (1.8%) did not know what e-prescription is. Of the remaining 448 individuals, 72.1% prefer e-prescription because it is more convenient for them. Most patients (62.1%) also recognize that e-prescribing makes it easier to purchase medications on behalf of another patient. Based on the study, it can be concluded that e-prescription is well evaluated by Polish patients. A large percentage of respondents were positive about obtaining prescriptions for continued treatment, without a personal doctor visit. Therefore, it is reasonable to maintain the possibility of such contact with a physician. The most popular, and preferred, method of receiving e-prescriptions is via SMS. However, it is necessary to offer different options for obtaining prescriptions, to meet the needs of different populations.

Multilevel Influences on Black Cancer Patient Experiences With Care: A Qualitative Analysis

PURPOSE: Black patients with cancer report worse experiences with health care compared with White patients; however, little is known about what influences these ratings. The objective of this study is to explore the multilevel factors that influence global ratings of care for Black cancer survivors. METHODS: We conducted semistructured in-depth interviews with 18 Black cancer survivors. We assessed the global ratings of their personal doctor, specialist, health plan, prescription drug plan, and overall health care, and asked patients to elaborate on their rating. We analyzed the interviews with a deductive grounded theory approach using the socioecologic model to identify the individual, interpersonal, organizational, and environmental influences on Black cancer patient experiences with global ratings of care. We used an inductive constant comparison approach to identify additional themes that emerged. Two coauthors separately coded a set of transcripts and met to refine the codebook. RESULTS: On average, participants reported the highest mean rating for their specialist (9.39/10) and the lowest mean rating for their personal doctor (7.33/10). Emerging themes that influenced patient ratings were perceptions about their interaction with medical providers, physician communication, the doctor's expertise, and aspects of the physical facilities. Global ratings of care measures were widely influenced by patient interactions with their providers that were empathetic, nondiscriminatory, and where the doctors addressed all concerns. CONCLUSION: This grounded theory study identifies multiple aspects of health care that intervention researchers, health care administrators, and providers may target to improve Black cancer patient experiences with care.

Patient Provider Continuity and Prostate Specific Antigen Testing: Impact of Continuity on Receipt of a Non-recommended Test

Background: Continuity of care with a regular physician has been associated with treatment adherence but it is unclear if continuity of care may lead to inappropriate treatments. We assessed the relationship between the receipt of prostate-specific antigen (PSA) screening, a non-recommended test, and having continuity with a single personal doctor.Methods: We analyzed the 2016 and 2018 Behavioral Risk Factor Surveillance System (BRFSS). Responses from men aged 40 and older with no symptoms or family history of prostate cancer were analyzed (unweighted n = 232,548, representing 36,919,766 individuals). Continuity with one doctor was analyzed in relation to discussions of advantages and disadvantages of PSA tests, provider recommendation to receive a test and receipt of a PSA test.Results: 39.5% of men received PSA screening during the time that the test was not recommended. Having a single personal doctor was associated with discussion of both advantages (53.3 vs. 29.7%, p < 0.001) and disadvantages (24.2 vs. 13.5%, p < 0.001) of PSA tests but also a recommendation to receive a PSA test (45.3 vs. 29.3%, p < 0.001). The adjusted odds of receiving a PSA test was higher among those with a single personal doctor compared to those without (OR 2.31; 95% CI, 2.17–2.46).Conclusion: In a nationally representative sample during the time when PSA screening was not recommended by the US Preventive Services Taskforce, having a single personal doctor was associated with both recommendations for the test and receipt of the test. These findings emphasize the importance of the patient physician relationship and the need for evidence-based care.

Az epilepsziás betegek ellátásának változása a COVID–19-járvány első veszélyhelyzeti periódusában

Összefoglaló. Bevezetés: A COVID–19-járvány világszerte hónapokra átalakította a járóbeteg-ellátás működését is. Magyarországon a 2020. március 11-től 2020. június 17-ig fennálló egészségügyi veszélyhelyzeti rendelkezések szabták meg az új kereteket. Célkitűzés: Az első veszélyhelyzeti periódus második felében, 2020. április 22. és 2020. május 5. között mértük fel az epilepsziaellátásban részt vevő orvosok véleményét, hogy milyen mértékben változott a betegek ellátása, és hogyan élték meg a változásokat személyesen. Módszer: Internetes kérdőíves véleményfelmérés történt, a Magyar Epilepszia Liga 2020. április 16–17-re tervezett, de a COVID–19-járvány miatt elhalasztott XV. kongresszusára regisztrált neurológusok között. Kilenc egyszeres vagy többszörös feleletválasztós kérdés és ’szabad kommentár’ mezők álltak rendelkezésre. Eredmények: A megkeresett 116 neurológus közül 33-an válaszoltak (28%), összesen 30 kommentár került rögzítésre. 73%-uk szerint a változások komoly nehézséget okoztak, 15%-uk gondolta, hogy ennek súlyos következményei lesznek. Új betegek fogadása 53%-ban leállt, 25%-ban nagy nehézségekbe ütközött. A gondozott betegek problémáit 49%-ban a távvizit lehetőségeivel élve meg tudták oldani, de 24%-ban ez nem sikerült. A beteg távollétében lebonyolított vizitek 68%-a dokumentált telefonbeszélgetések formájában zajlott. Az orvosok kétharmada veszélyeztetve érezte magát, hogy elkapja a vírust, ebből 40% úgy érezte, nem kap elegendő védelmet, 6% (2 fő) kapta el a fertőzést. Következtetés: A COVID–19-járvány a leginkább az új szakvélemények kiadását érintette, de a gondozási feladatokat sem mindig lehetett megfelelően megoldani. A károkat jelentősen enyhítette az ellátószemélyzet rugalmassága. A telefonvizitek, szükség esetén, az epileptológiában pótolhatják a személyes orvos-beteg találkozásokat. A járvány visszatérésének veszélye miatt a távvizit-alkalmazások technikai fejlesztése és ezek dokumentálási kérdéseinek megoldása fontos. A járványidőszakban a személyzet védelmére nagy figyelmet kell fordítani a fertőződés elkerülése és az orvosok biztonságérzetének fokozása érdekében. Orv Hetil. 2020; 161(46): 1939–1943. Summary. Introduction: COVID-19 pandemic has transformed the operation of outpatient care worldwide for months. The new framework was set in Hungary by the health emergency regulations that existed from 11. 03. 2020 to 17. 06. 2020. Objective: In the second half of the emergency period, between 22. 04. 2020 and 05. 05. 2020, we surveyed the opinion of physicians involved in epilepsy care about the extent to which patient care had changed and how they experienced the changes in person. Method: An internet questionnaire survey was conducted among neurologists registered for the annual congress of the Hungarian Chapter of the International League Against Epilepsy. Nine single- or multiple-choice questions and ‘free comment’ fields were available. Results: Of 116 neurologists contacted, 33 responded (28%), and a total of 30 comments were recorded. 73% said the changes caused a serious difficulty, 15% thought it would have serious consequences. Reception of new patients was stopped in 53%, and 25% encountered great difficulties. In 49%, the problems of the cared patients could be solved using remote visits, but 24% could not solve them properly. 68% of outpatient visits took the form of documented telephone conversations. Two-thirds of doctors feared catching the virus, 40% of whom felt they were not getting enough protection. 6% caught the infection. Conclusion: The COVID-19 pandemic has mostly affected the issuance of new expert opinions, but care tasks have not always been adequately addressed. The damage was significantly mitigated by the flexibility of the care staff. Telephone visits, if necessary, can replace personal doctor-patient encounters in epileptology. The technical development of remote visit applications and their documentation issues are important. During the pandemic period, great care must be taken to protect staff in order to avoid infection and increase the sense of safety of doctors. Orv Hetil. 2020; 161(46): 1939–1943.

Perceptions of care coordination among older adult cancer survivors: A SEER-CAHPS study.

178 Background: Care coordination represents deliberate efforts to harmonize and organize patient care activities. This study examined sociodemographic and clinical predictors of patient-reported care coordination among Medicare beneficiaries older than 65 with a history of cancer. Methods: This study utilized the Surveillance, Epidemiology, and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) linked data, including SEER cancer registry data, Medicare CAHPS patient experience surveys, and Medicare claims. We identified Medicare beneficiaries who completed a CAHPS survey within ten years after their most recent cancer diagnosis and reported visiting a personal doctor within six months before their survey (n = 14,646). Multivariable regression models examined associations between cancer survivor characteristics and care coordination, with higher scores indicating better coordination (scale of 0-100). Results: Residing in a rural area at time of diagnosis (1.2-points greater score than urban; p= 0.04) and reporting > 4 visits with a personal doctor within 6 months (3.0-points greater than 1-2 visits; p< 0.001) were significantly associated with higher care coordination scores. Older age ( p< 0.001) and seeing more specialists ( p= 0.006) were associated with significantly lower care coordination scores. Patients with melanoma (women: 5.2-point difference, p< 0.001; men: 2.8 points, p= 0.01) and breast cancer (women: 2.4 points; p< 0.001) also reported significantly lower care coordination scores than did men with prostate cancer (reference group). Conclusions: Adult cancer survivors who are older, have a history of breast, lung, or melanoma cancers, or see more specialists report worse care coordination. Future research should explore and address the multilevel influences that lead to worse care coordination for older adult cancer survivors.

Evaluation of quality and reliability of websites about orthognathic surgery using Google Trends™ application

Objectives: Orthognathic surgery is the only treatment option for some cases in orthodontics. Two main goals were aimed in this study. The first goal was to determine the top three keywords that Google searchers look for “orthognathic surgery” using the Google Trends™ application. The second was to assess the quality and reliability of the webpages yielded by searching those four keywords on Google. Materials and Methods: Google Trends was searched using the keyword “Orthognathic Surgery.” Then, Google was searched using keywords: “Orthognathic surgery” and the other first three keywords. An oral surgeon and an orthodontist analyzed the quality and reliability of the websites using the DISCERN assessment tool. Results: The correlation between evaluators was low. Forty-six of the 70 websites were the websites of different oral and maxillofacial clinics and orthodontic clinics. The percentage of websites was 11% for personal doctor websites, 10% for academic journals, 7% for institutes, 6% for orthodontic clinics, and 1.4% for dental clinics. Overall rating scores of the websites for researchers were 2.41±1.35 for oral surgeon and 1.99±1.49 for orthodontist. Conclusions: The reliability and quality of the information in all of the websites was very low. The data on the websites did not have any scientific review processes such as review-peer review.

Patients’ perception of communication at the interface between primary and secondary care: a cross-sectional survey in 34 countries

Background Poor communication between general practitioners (GPs) and medical specialists can lead to poorer quality, and continuity, of care. Our study aims to assess patients’ perceptions of communication at the interface between primary and secondary care in 34 countries. It will analyse, too, whether this communication is associated with the organisation of primary care within a country, and with the characteristics of GPs and their patients. Methods We conducted a cross-sectional survey among patients in 34 countries. Following a GP consultation, patients were asked two questions. Did they take to understand that their GP had informed medical specialists about their illness upon referral? And, secondly, did their GP know the results of the treatment by a medical specialist? We used multi-response logistic multilevel models to investigate the association of factors related to primary care, the GP, and the patient, with the patients’ perceptions of communication at the interface between primary and secondary care. Results In total, 61,931 patients completed the questionnaire. We found large differences between countries, in both the patients’ perceptions of information shared by GPs with medical specialists, and the patients’ perceptions of the GPs’ awareness of the results of treatment by medical specialists. Patients whose GPs stated that they ‘seldom or never’ send referral letters, also less frequently perceived that their GP communicated with their medical specialists about their illness. Patients with GPs indicating they ‘seldom or never’ receive feedback from medical specialists, indicated less frequently that their GP would know the results of treatment by a medical specialist. Moreover, patients with a personal doctor perceived higher rates of communication in both directions at the interface between primary and secondary care. Conclusion Generally, patients perceive there to be high rates of communication at the interface between primary and secondary care, but there are large differences between countries. Policies aimed at stimulating personal doctor arrangements could, potentially, enhance the continuity of care between primary and secondary care.

Can Health Literacy Boost Health Services Utilization in the Context of Expanded Access to Health Insurance?

Background. Health insurance access and health literacy are critical components of “enabling resources” to encourage uptake of services. We sought to test whether health literacy boosts health services utilization in the context of expanded access to health insurance stemming from the Affordable Care Act. Method. We used individual-level data from 11 states included in the Behavioral Risk Factor Surveillance System 2016. We conducted a two-stage least squares instrumental variables analysis. We instrumented improved access to health insurance stemming from Affordable Care Act Medicaid expansion. As outcome variables, we examined cost as a barrier to needed care, having a personal doctor and receipt of routine health checkups, flu shots, Pap tests, mammograms, sigmoidoscopy/colonoscopy, and dental visits in the past year. We then tested whether the relation between improved health insurance access and health services utilization was moderated by health literacy. Health literacy was measured by a dichotomized scale comprising three items: difficulties obtaining advice or information about health, difficulties understating information from health professionals, and difficulties understanding written health information. Results. We found that improving health insurance access increased the likelihood of reporting a personal doctor while reducing the likelihood of reporting cost as a barrier to care. We also found an interaction effect between health insurance and health literacy on dental visits. However, there was no significant interaction effect between insurance access and health literacy for preventive services utilization. Conclusion. Health literacy did not explain why people fail to access preventive services even when they obtain access to insurance, with the sole possible exception of dental visits among individuals with high literacy.

A method for measuring continuity of care in day-to-day general practice: a quantitative analysis of appointment data

BackgroundDespite patient preference and many known benefits, continuity of care is in decline in general practice. The most common method of measuring continuity is the Usual Provider of Care (UPC) index. This requires a number of appointments per patient and a relatively long timeframe for accuracy, reducing its applicability for day-to-day performance management.AimTo describe the St Leonard’s Index of Continuity of Care (SLICC) for measuring GP continuity regularly, and demonstrate how it has been used in service in general practice.Design and settingAnalysis of appointment audit data from 2016–2017 in a general practice with 8823–9409 patients and seven part-time partners, in Exeter, UK.MethodThe percentage of face-to-face appointments for patients on each doctor’s list, with the patient’s personal doctor (the SLICC), was calculated monthly. The SLICC for different demographic groupings of patients (for example, sex and frequency of attendance) was compared. The UPC index over the 2 years was also calculated, allowing comparisons between indices.ResultsIn the 2-year study period, there were 35 622 GP face-to-face appointments; 1.96 per patient per year. Overall, 51.7% (95% confidence interval = 51.2 to 52.2) of GP appointments were with the patients’ personal doctor. Patients aged ≥65 years had a higher level of continuity with 64.9% of appointments being with their personal doctor. The mean whole-practice UPC score was 0.61 (standard deviation 0.23), with ‘usual provider’ being the personal GP for 52.8% and a trainee or locum for 8.1% of patients.ConclusionThis method could provide working GPs with a simple way to track continuity of care and inform practice management and decision making.