Risk factors for clinically relevant deviations in patients’ medication lists reported by patients in personal health records: a prospective cohort study in a hospital setting

Background Personal health records have the potential to identify medication discrepancies. Although they facilitate patient empowerment and broad implementation of medication reconciliation, more medication discrepancies are identified through medication reconciliation performed by healthcare professionals. Aim We aimed to identify the factors associated with the occurrence of a clinically relevant deviation in a patient’s medication list based on a personal health record (used by patients) compared to medication reconciliation performed by a healthcare professional. Method Three- to 14 days prior to a planned admission to the Cardiology-, Internal Medicine- or Neurology Departments, at Amphia Hospital, Breda, the Netherlands, patients were invited to update their medication file in their personal health records. At admission, medication reconciliation was performed by a pharmacy technician. Deviations were determined as differences between these medication lists. Associations between patient-, setting-, and medication-related factors, and the occurrence of a clinically relevant deviation (National Coordinating Council for Medication Error Reporting and Prevention class $$\ge$$ ≥ E) were analysed. Results Of the 488 patients approached, 155 patients were included. Twenty-four clinically relevant deviations were observed. Younger patients (adjusted odds ratio (aOR) 0.94; 95%CI:0.91–0.98), patients who used individual multi-dose packaging (aOR 14.87; 95%CI:2.02–110), and patients who used $$\ge$$ ≥ 8 different medications, were at highest risk for the occurrence of a clinically relevant deviation (sensitivity 0.71; specificity 0.62; area under the curve 0.64 95%CI:0.52–0.76). Conclusion Medication reconciliation is the preferred method to identify medication discrepancies for patients with individual multi-dose packaging, and patients who used eight or more different medications.

How End-of-Life Blogs Re-Affirm the “Power to be Oneself”

Powerlessness generally denotes loss of control and may be experienced among those with a terminal diagnosis and, as such, empowerment is a dominant discourse in end-of-life policy in the western Anglo-Saxon world. This paper analyzes thematically blogs authored by three people with a terminal diagnosis to examine the “power to be oneself,” a concept which was identified in the “Ethics of Powerlessness” project conducted in the UK. The analysis demonstrates that the bloggers assert the “power to be themselves” which is expressed in three principal ways. Firstly, through assertion of agency to promote self-affirmation and control. Secondly, through claiming a “moral authority” expressed by providing advice not just on illness and death but also on how life should be lived. Thirdly, through discussing ideas about the future and creating a legacy. The blogs are a mechanism used to express and reinforce self-identity and to carve out a “sacred space” between life and death to nurture personal change and to project this onto a public arena. This analysis demonstrates the key role patient empowerment plays in constructing an identity with a terminal diagnosis, an element that is often overlooked in end-of-life policy.

Empowering Patients Through Digital Technologies

Mobile health initiatives aim to give patients more medical information and to empower them over their medical treatments. However, information overload and lack of digital literacy may hinder patient empowerment. This chapter investigates opportunities and challenges of patient empowerment and mobile health. The authors analyze the different definitions used in the literature to characterize patient empowerment and mobile health, discussing implications for all the care actors involved. Although the adoption rate of mobile technologies is at its infant stage and challenges still outweigh the benefits of patient empowerment, mobile health apps can foster the progress towards patient-centered care.

Approaching Empowerment Holistically: are Physicians Willing And Able?

Patient empowerment is evident nowadays through the increased role undertaken by patients in the evaluation of healthcare, shaping health policy and involvement in clinical research. But are physicians willing and able to empower their patients? The biopsychosocial model offers a holistic approach to care by including the subjective experience of illness into clinical processes. Within this context, effective communication is key as it can contribute towards better clinical outcomes for patients as well as protect physicians from burnout due to emotional exhaustion. Hematological malignancies are the focus of this contribution as their nature and management pose serious challenges for patients to understand and physicians to explain. Physicians can play a pivotal role in encouraging patients' empowerment by educating them about their illness, supporting them in self-management and involving them in their care. Communication skills training, availability of consultation tools and e-health applications can support physicians in their new role.

Learning to Live with Chronic Disease

Cardiovascular diseases are chronic diseases with the highest morbidity and mortality rate worldwide. The high number of hospital admissions for coronary artery disease and the low adherence to cardiac rehabilitation programs constitute an opportunity for nurses to develop educational interventions aimed at health promotion, health literacy, empowerment, and accountability of the patient's abilities for an effective self-care. Nurses need to understand chronic patient's priorities and implement patient-centered care considering that caring for patients with chronic disease requires interventions focused on individual human responses. Therefore, the intention of this chapter is to provide an overview of the impact of educational nursing interventions on health literacy and patient empowerment as a method to improve self-care skills that are necessary for dealing with chronic disease.

Digital Health Services through Patient Empowerment: Classification, Current State and Preliminary Impact Assessment by Health Pod Systems

Health pods are new systems such as small spaces equipped with medical devices where users can measure several biomedical parameters related to their health status and receive other medical services. Their impact on health over a life course could be relevant in defining healthy aging strategies and/or management of chronic diseases and the early detection of possible symptoms related to some common pathologies. The generated data have not only a personal value but even at a community/society level. Health pods also support educational and empowerment actions to enable the 5P medicine approach, and specifically prevention, health promotion, and public health policymaking. This paper aims at defining their taxonomy, conducting a market and typologies survey, and discussing their potential impact in preventive medicine, presenting data of a pilot test carried out placing two health pods in a superstore environment to validate the demand and the participation of people in a prevention campaign. A 57-day period was observed at two sites: the number of free accesses and administered tests was impressive for size and completeness. The test revealed a good picture of the general health status of the population, with satisfying AGE values in the cardiovascular check and stress index through an HRV analysis. The body composition test revealed a small number of overweight subjects, more in males than in females. This pilot confirmed the huge demand for personalized services for improving well-being, health status, and quality of life and the relevance of these solutions for their individual and societal impact in preventive medicine.

The Role of EUPATI CH in Promoting Patient Involvement in Clinical Research: A Multi-Stakeholder Research Project

Background: The European Patients' Academy on Therapeutic Innovation Switzerland (EUPATI CH) was established as an association in 2016 with the mission to improve patient empowerment in Switzerland, raise public awareness of EUPATI's education material, and foster multi-stakeholder partnerships in order to promote public involvement in all aspects of medicines research and development (R&D). In order to achieve its goal of improving patient involvement (PI) in all processes of medicines R&D in Switzerland and to obtain guidance and recommendations for future activities, EUPATI CH initiated a multi-stakeholder survey on PI experiences, hurdles, and best practices. The survey enabled EUPATI CH to obtain and analyze the views of various stakeholders and shape its workplan.Methods: Data collection occurred between January and July 2019 using a survey and semi-structured interviews with individual stakeholders from different groups. The online survey responses were analyzed using quantitative methods and the interviews were analyzed using qualitative methods.Results: The online survey was completed by 55 respondents (10%), and the semi-structured interviews were conducted with 14 stakeholders. Respondents to the online survey were patient representatives (45%), researchers from academia (25%), individuals from the pharmaceutical industry (9%), healthcare professionals (23%), and representatives from government agencies (6%). Some respondents were also members of EUPATI CH. Thirty-eight percent of respondents consider PI in Switzerland to be limited or absent. They identified the main barriers to PI as, first and foremost, a lack of funds and human resources (65%), followed by a lack of information and a lack of education on how to become a patient advocate (21%), a lack of collaboration with other stakeholders (16%), and a lack of adequate resources. Respondents' expectations of EUPATI CH's role in supporting PI were to provide education for active PI and improve networking and collaboration among stakeholders.Conclusions: EUPATI CH's multi-stakeholder research identified some of the difficulties in promoting PI in medicines R&D in Switzerland, in particular the complex collaboration among stakeholders and a lack of funds, human resources, and knowledge. To respond to these difficulties, EUPATI CH has begun preparing a basic training course for patients that is adapted to Switzerland.

Interactive System for Similarity-Based Inspection and Assessment of the Well-Being of mHealth Users

Recent digitization technologies empower mHealth users to conveniently record their Ecological Momentary Assessments (EMA) through web applications, smartphones, and wearable devices. These recordings can help clinicians understand how the users’ condition changes, but appropriate learning and visualization mechanisms are required for this purpose. We propose a web-based visual analytics tool, which processes clinical data as well as EMAs that were recorded through a mHealth application. The goals we pursue are (1) to predict the condition of the user in the near and the far future, while also identifying the clinical data that mostly contribute to EMA predictions, (2) to identify users with outlier EMA, and (3) to show to what extent the EMAs of a user are in line with or diverge from those users similar to him/her. We report our findings based on a pilot study on patient empowerment, involving tinnitus patients who recorded EMAs with the mHealth app TinnitusTips. To validate our method, we also derived synthetic data from the same pilot study. Based on this setting, results for different use cases are reported.

Digitale Zukunft als Chance – Teledermatologie-Erfahrungen aus der Praxis

Zusammenfassung Hintergrund Verbesserte regulatorische Rahmenbedingungen und die Corona-Pandemie als Katalysator für die Digitalisierung im Gesundheitssystem haben zu einem umfassenden telemedizinischen Angebot geführt. Auf die Dermatologie entfällt dabei ein Drittel der telemedizinischen Leistungen. Die Ausgestaltung der teledermatologischen Leistung variiert dabei je nach Anbieter stark. Die Unterschiede sowie Vor- und Nachteile sind dabei sowohl für Ärztinnen und Ärzte als auch für Patientinnen und Patienten oftmals nicht ersichtlich. Fragestellung Das Ziel des Beitrags ist daher, einen Überblick zu den Formen und aktuellen Einsatzgebieten der Teledermatologie zu schaffen. Darüber hinaus sollen die Einsatzmöglichkeiten der Anwendungsgebiete in der Teledermatologie eingeordnet werden und anhand von persönlichen Erfahrungen mit einer dermatologischen Telemedizin-Plattform exemplarisch beschrieben werden. Material und Methode Zur Darstellung der Teledermatologie in Deutschland wurde eine Übersichtsarbeit erstellt, die aktuelle nationale und internationale Studien und Befragungen zum Einsatz der Teledermatologie umfasst. Die exemplarische Vorstellung der asynchronen Teledermatologie am Beispiel des Angebots „OnlineDoctor“ erfolgt anhand von qualitativen Interviews der Autoren mit teilnehmenden Dermatologinnen und Dermatologen sowie öffentlich zugänglichen Produktinformationen. Ergebnisse In einem Großteil der dermatologischen Fälle ist eine hohe Konkordanz der Diagnose und Patientenzufriedenheit unter Nutzung teledermatologischer Anwendungen erkennbar. Sowohl im Kontext der Diagnosestellung als auch bei der Versorgung chronischer Patientinnen und Patienten und dem Triagieren sind die Vorteile evaluiert. Dabei weisen die verschiedenen teledermatologischen Verfahren insbesondere mit Blick auf die genutzte Technologie (synchron bzw. asynchron) große Unterschiede auf. Die Vorteile der asynchronen Teledermatologie liegen dabei primär in der zeitlichen und örtlichen Flexibilität sowie dem breiten Anwendungsspektrum. Versorgungsdaten aus dem Alltag der beiden Autoren stützen die Aussage, dass Teledermatologie bei gleicher medizinischer Qualität positive Effekte für Patientinnen und Patienten sowie Praxen hat. Diskussion Die Teledermatologie hat das Potenzial, Prozesse in Praxen zu verbessern und näher an der Patientin und dem Patienten zu arbeiten. Dabei ist unter dem Stichwort „Patient Empowerment“ eine patientenzentrierte Medizin anzustreben und die Möglichkeiten der digitalen Anwendungen sind zu nutzen. Die Autoren gehen davon aus, dass sich in den kommenden Jahren sowohl die Indikationen, die via Telemedizin diagnostiziert werden können, als auch die Einsatzfelder erweitern werden. Die Zukunft wird eine weitere Individualisierung des digitalen Angebotes ermöglichen und die kombinierte Nutzung von digitalen Tools und analogen Untersuchungen in der Praxis zum Goldstandard werden lassen.