Ahmad Haerian; Ali Moemen; Saeede Asgari; Farzane Vaziri
Introduction: health literacy is a fundamental part of the healing promotion. The aim of this study was to evaluate periodontal health literacy among patients. Materials and methods: 296 patients attending periodontal clinic who were above 16 years old participated in this study. Gathering data was based on screening questions on a 5-point Likert scale. After completion questionnaire, data was analyzed by Mann-Whitney and Kruskal-Wallis test. Based on the scores of questions, patients were cl...
Nora Sexto Delgado
Full Text Available Background: Buccal health as integral and determinant part of general health makes us find different ways and methods to elevate life quality in the population. Objective: To establish the risk of suffering from dental cavities in asthmatic patients. Methods: A non match case and control study constituted by 100 children selected at simple random from the universe of asthmatic patients belonging to the General Comprehensive doctor offices number 7,9,10, 11, 43, and 44 from Area II in Cienfuegos municipality. The controlled group was selected in the same offices but from the universe of non asthmatic children. The age in both groups was from 6 to 15 years old. Visits to the children´s home were carried out for the record of the information through health oral dental and buccal health knowledge surveys. Results: The index of cavities, lost, and obturated permanent teeth was higher (3, 28 than in the control group (0, 44. The buccal hygiene indexes and the level of knowledge in both groups did not show significant differences. The most used drugs in asthma therapy were salbutamol and ketotifeno which change the buccal milieu. The odds ratio technique between asthmatic and non asthmatic patients showed 4, 9 times more at risk of suffering from dental cavities in the first group. Finally, it can be stated that the asthmatic patients are more at risk of suffering from cavities than the non asthmatic ones, so a program for buccal health in these patients should be performed.
Coleman, R; Body, J J; Aapro, M;
There are three distinct areas of cancer management that make bone health in cancer patients of increasing clinical importance. First, bone metastases are common in many solid tumours, notably those arising from the breast, prostate and lung, as well as multiple myeloma, and may cause major...... morbidity including fractures, severe pain, nerve compression and hypercalcaemia. Through optimum multidisciplinary management of patients with bone metastases, including the use of bone-targeted treatments such as potent bisphosphonates or denosumab, it has been possible to transform the course of advanced...... cancer for many patients resulting in a major reduction in skeletal complications, reduced bone pain and improved quality of life. Secondly, many of the treatments we use to treat cancer patients have effects on reproductive hormones, which are critical for the maintenance of normal bone remodelling...
of patient involvement in health care. This framework is used to analyse key governance features of patient involvement in Denmark based on previous research papers and reports describing patient involvement in Danish health care. Findings – Patient involvement is important in Denmark at the...... research results may lack generalisability. Practical implications – The paper includes implications for the development of patient involvement in health care. Originality/value – This paper fulfils a need to study different types of patient involvement and to develop a theoretical framework for...... characterizing and analysing such involvement strategies. Keywords: patient involvement, health care...
Crotty, Bradley H; Slack, Warner V
Patients are increasingly interacting with their healthcare system through online health services, such as patient portals and telehealth programs. Recently, Shabrabani and Mizrachi provided data outlining factors that are most important for users or potential users of these online services. The authors conclude convincingly that while online health services have great potential to be helpful to their users, they could be better designed. As patients and their families play an increasingly ac...
Nielsen, Karen Dam
With e-health technologies, patients are invited as co-producers of data and information. The invitation sparks new expectations, yet often results in disappointments. With persistent ambitions to involve patients by means of e-health, it seems crucial to gain a better understanding of the nature......, sources and workings of the expectations that come with being invited. I analyse the use of an e-health system for ICD-patients, focusing on how patients sought to serve as information providers. Continuing STS-research on invisible work in technology use, I show how using the system involved complex work...... that understanding the dialogic dynamics and ‘overflows’ of information filtration work can help unpack the challenges of facilitating (patient) participation with e-health and other filtration devices....
Full Text Available Although oral health is a major determinant of general health and quality of life, it has a low priority in the context of mental illness. Chronic mental illness and its treatment carry inherent risks for significant oral diseases. Both the disease itself and its various pharmacologic management modalities lead to a range of oral complications and side effects, with caries, periodontal disease and xerostomia being encountered most frequently. Older age, female gender, length of hospitalization, duration of mental illness, psychiatric diagnosis are the most discussed predictors for adverse dental outcomes in the reviewed studies. Poor oral hygiene, higher intake of carbonates, smoking, poor perception of oral health self-needs, length of psychiatric disorder, length of psychotropic treatment, and less access to dental care pose at high risk for poor oral health among this population. This article emphasizes the importance of preventive dentistry programs to improve dental healthcare psychiatric chronic inpatients and the signifance of bridging dental health education to psychiatric rehabilitation programs. In this review, general information concerning the oral manifestations of mental illness, effect of medication of mental illness on oral health, the factors affecting oral health among this special population have been provided.
McCaffery, K; Holmes-Rovner, M.; S. Smith; Rovner, D.; Nutbeam, Don; Clayman, M.L.; Kelly-Blake, K.; Wolf, M.(University of Notre Dame, Notre Dame, USA); Stacey, S
Background Effective use of a patient decision aid (PtDA) can be affected by the user’s health literacy and the PtDA’s characteristics. Systematic reviews of the relevant literature can guide PtDA developers to attend to the health literacy needs of patients. The reviews reported here aimed to assess: 1. a) the effects of health literacy / numeracy on selected decision-making outcomes, and b) the effects of interventions designed to mitigate the influence of lower health literacy on decision-...
for analysis of patient involvement in health care. This framework is used to analyze key governance features of patient involvement in Denmark based on previous research papers and reports describing patient involvement in Danish health care. FINDINGS: Patient involvement is important in Denmark...... be identified when pursuing the strategies at the same time. RESEARCH LIMITATIONS/IMPLICATIONS: Because of the chosen research approach, the research results may lack generalizability. Therefore, researchers are encouraged to test the proposed framework further. PRACTICAL IMPLICATIONS: The paper includes...... implications for the development of patient involvement in health care. ORIGINALITY/VALUE: This paper fulfills a need to study different types of patient involvement and to develop a theoretical framework for characterizing and analyzing such involvement strategies....
Ozlem Gurbuz; Kursat Altinbas; Erhan Kurt
Although oral health is a major determinant of general health and quality of life, it has a low priority in the context of mental illness. Chronic mental illness and its treatment carry inherent risks for significant oral diseases. Both the disease itself and its various pharmacologic management modalities lead to a range of oral complications and side effects, with caries, periodontal disease and xerostomia being encountered most frequently. Older age, female gender, length of hospitalizatio...
Sumner, W.; Truszczynski, M.; Marek, V. W.
The American Board of Family Practice is developing a computer-based recertification process to generate patient simulations from a knowledge base. Simulated patients require a stochastically generated history and response to treatment, suggesting a Monte Carlo-like patient generation process. Knowledge acquisition experiments revealed that description of a patient's overall health as a node in a Monte Carlo model was difficult for domain experts to use, severely limited knowledge reusability...
Crotty, Bradley H; Slack, Warner V
Patients are increasingly interacting with their healthcare system through online health services, such as patient portals and telehealth programs. Recently, Shabrabani and Mizrachi provided data outlining factors that are most important for users or potential users of these online services. The authors conclude convincingly that while online health services have great potential to be helpful to their users, they could be better designed. As patients and their families play an increasingly active role in their health care, online health services should be made easier for them to use and better suited to their health-related needs. Further, the online services should be more welcoming to people of all literacy levels and from all socioeconomic backgrounds. PMID:27307985
Friel, Catherine J
According to the National Assessment of Adult Literacy (2003), only 12% of U.S. adults have a proficient level of health literacy, with adults 65 years and older more likely to have a below basic or a basic health literacy level. An estimated 5.8 million individuals in the United States have heart failure (HF) and it is one of the most common reasons for those aged 65 and over to be hospitalized. Many patients with HF are at risk for poor health outcomes due to low health literacy. This article reviews the literature with regard to the effectiveness of methods used to address low health literacy among HF patients and describes a pilot study implemented by a home care agency in the northeast to address high HF readmission rates. PMID:27580282
Andrew Mulcahy; Tom Walley
Health Technology Assessment (HTA) is a process used to evaluate the clinical effectiveness and costeffectiveness of health technologies by a systematic review of clinical, economic, and utilization research.
Despite widespread investment in patient safety technologies in the U.K., U.S., and elsewhere, little HTA has been done to establish the clinical or cost-effectiveness of these technologies. The HTA and patient safety literature suggests there are four categori...
Clark, David B
Mental illness is a major health issue in the world today, yet often remains misunderstood, unrecognized, and undertreated. Patients suffering from severe psychiatric disorders generally display poor oral health, often as a consequence of both lifestyle and avoidant-type behaviors that become exacerbated by their illness. Individuals with severe mental illness display a greater incidence of oral disease compared with a similar demographic not dealing with these particular disorders. Efforts to enhance the oral health of these vulnerable patients will play a significant role in the overall rebuilding of their self-esteem and contribute positively to their journey toward stability and recovery. PMID:27264850
Higgins, John P
Healthcare providers are often looking for ways to objectively monitor and improve their patients' health and fitness, especially in between patient visits. Some insurance companies are using applications data as incentives to improve health and lower premiums. As more and more people start to use smartphones, they may provide a tool to help improve a patient's health and fitness. Specifically, fitness applications or "apps" on smartphones are programs that use data collected from a smartphone's inbuilt tools, such as the Global Positioning System, accelerometer, microphone, speaker, and camera, to measure health and fitness parameters. The apps then analyze these data and summarize them, as well as devise individualized plans based on users' goals, provide frequent feedback, personalized coaching, and additional motivation by allowing milestones to be shared on social media. This article introduces evidence that apps can better help patients reach their health and fitness goals. It then discusses what features to look for in an app, followed by an overview of popular health and fitness apps. Last, patient scenarios with app recommendations, limitations of apps, and future research are discussed. PMID:26091764
Matzo, Marianne; Troup, Sandi; Hijjazi, Kamal; Ferrell, Betty
This article shares the findings of an evaluation of a patient teaching resource for sexual health entitled Everything Nobody Tells You About Cancer Treatment and Your Sex Life: From A to Z, which was accomplished through systematic conceptualization, construction, and evaluation with women diagnosed with breast or gynecologic cancer. This resource, which has evolved from patient-focused research and has been tested in the clinical setting, can be used in patient education and support. Oncolo...
... Patient portals, patient health record (PHR) systems, and electronic health record (EHR) systems can use MedlinePlus Connect to provide health information for patients, families, and healthcare providers using standard ...
Τogas Κ.; Alexias G.
Background: Lung cancer is a very common type of cancer. The psychological reactions of these patients haven't been studied yet. Aim: The examination of the mental health of lung cancer patients. Methods: A bibliographical review of relevant articles was conducted at the electronic data bases of Pubmed, Pcych Info and Scholar Google by key-words. The quest included researches and reviews which have been published in Greek and English language between 1990- 2013. Results: Lung canc...
Kerssens, J.J.; Bensing, J.M.; Andela, M.G.
Preferences for physicians' gender is an obvious and well documented example of considerations of patients' attitudes. But research carried out in this field is rather limited to the domain of family medicine. This article describes preferences for 13 different health professions: surgeons, neurolog
Kerssens, J. J.; BENSING, J; Andela, M.G.
Preferences for physicians' gender is an obvious and well documented example of considerations of patients' attitudes. But research carried out in this field is rather limited to the domain of family medicine. This article describes preferences for 13 different health professions: surgeons, neurologists, anaesthetists, internists, general practitioners, psychiatrists, psychologists, social workers, hospital and district nurses, home helps, gynaecologists and midwives. Our investigation also c...
Full Text Available The introduction of a national electronic health record system to the National Health Service (NHS has raised concerns about issues of data accuracy, security and confidentiality. The primary aim of this project was to identify the extent to which primary care patients will allow their local electronic record data to be shared on a national database. The secondary aim was to identify the extent of inaccuracies in the existing primary care records, which will be used to populate the new national Spine. Fifty consecutive attenders to one general practitioner were given a paper printout of their full primary care electronic health record. Participants were asked to highlight information which they would not want to be shared on the national electronic database of records, and information which they considered to be incorrect. There was a 62% response rate (31/50. Five of the 31 patients (16% identified information that they would not want to be shared on the national record system. The items they identified related almost entirely to matters of pregnancy, contraception, sexual health and mental health. Ten respondents (32% identified incorrect information in their records (some of these turned out to be correct on further investigation. The findings in relation to data sharing fit with the commonly held assumption that matters related to sensitive or embarrassing issues, which may affect how the patient will be treated by other individuals or institutions, are most likely to be censored by patients. Previous work on this has tended to ask hypothetical questions concerning data sharing rather than examine a real situation. A larger study of representative samples of patients in both primary and secondary care settings is needed to further investigate issues of data sharing and consent.
Storgaard, Filip Holst; Pedersen, Christina Gravgaard; Jensen, Majbritt Lykke; Jensen, Steen Lund
Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome.......Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome....
Full Text Available Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE, a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of “health smart cards” that carry vital patient medical information in the form of a “credit card” or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart card might include physician buy-in for use in his or her everyday practice. Training and technical support should also be available to ensure the smooth implementation of this system. Despite these challenges, implementation of a health smart card moves us closer to seamless care in our country, thereby increasing the productivity and quality of healthcare.
Kelly W. Muir; Lee, Paul P.
In 1997, Ebrahimzadeh, Davalos and Lee wrote in this journal that only 32% of the ophthalmic patient educational materials reviewed were written at or below the recommended eighth grade reading level. Since that time, the National Assessment of Adult Literacy found that more than one third of adult Americans possess only basic or below basic health literacy skills, defined as the ability to understand written information in a healthcare setting. Subsequently, investigators have shown that poo...
Ladegaard Grønkjær, Lea; Vilstrup, Hendrik
Services Research report on the Danish population’s dental status. Results: One hundred and seven patients participated. Their oral care habits and self-perceived oral health were poorer than the Danish population; the patients had fewer teeth (on average 19 vs. 26, P=0.0001), attended the dentist less...... frequently (P=0.001), more rarely brushed teeth (P=0.001) and had problems with oral dryness (68 vs. 14%, P=0.0001). The patients’ mean OHIP score was 5.21±7.2, with the most commonly reported problems being related to taste and food intake. An association was observed between the OHIP score and the patients...
Behr, Joshua G.; Diaz, Rafael; Akpinar-Elci, Muge
The management and treatment of adult asthma has been associated with utilization of health services. Objectives: First, to investigate the likelihood of health service utilization, including primary care, emergency department, and hospital stays, among persons diagnosed with an asthma condition relative to those that do not have an asthma condition. Second, to examine the likelihood of poor physical health among asthma respondents relative to those that do not have an asthma condition. Third, to demonstrate that these relationships vary with frequency of utilization. Fourth, to discuss the magnitude of differences in frequent utilization between asthma and non-asthma respondents. Data Source: Data is derived from a random, stratified sampling of Hampton Roads adults, 18 years and older (n = 1678). Study Design: Study participants are interviewed to identify asthma diagnosis, access to primary care, frequency of emergency department utilization, hospital admissions, and days of poor physical health. Odds-ratios establish relationships with the covariates on the outcome variable. Findings: Those with asthma are found more likely (OR 1.50, 95% CI 1.05–2.15) to report poor physical health relative to non-asthma study participants. Further, asthma respondents are found more likely (OR 4.23, 95% CI 1.56–11.69) to frequently utilize primary care that may be associated with the management of the condition and are also more likely to utilize treatment services, such as the emergency department (OR 1.87, 95% CI 1.32–2.65) and hospitalization (OR 2.21, 95% CI 1.39–3.50), associated with acute and episodic care. Further, it is a novel finding that these likelihoods increase with frequency of utilization for emergency department visits and hospital stays. Conclusion: Continuity in care and better management of the diseases may result in less demand for emergency department services and hospitalization. Health care systems need to recognize that asthma patients are
Full Text Available A full understanding of and a competent approach to dying patients may lead to a more qualitative service delivery, an enhanced quality of life paradigms, and the patients’ wellbeing, all of which remain the ultimate goal of health care practice. The modern world has developed in parallel with secularism and religious diversity. This paper aims to illustrate the secularization process in Britain (with indications of generalized meanings and juxtaposes it with a description of the needs of dying patients regarding the meanings of religion and nonreligion. Although this paper draws on and provides a review of selected theoretical literature, it also addresses a significant challenge: the lack of scientifi c research on the subject. Hence, this paper aims to give an overview of the issues, but not synthesise them. The arguments that are elaborated in the paper are also supported by the author’s current research project in the city of London. The approach here is client oriented, and concerns social and health care. Practitioners ought to become competent, and maintain their competence throughout their professional career. Religious competence seems to have not been at the centre of discussions, regardless of the historical pathway that religious discourse has drawn since the beginnings of humanity. The paper concludes with certain suggestions for future research and inclusive approaches regarding religious matters.
... mission and primary activity is to conduct activities to improve patient safety and the quality of health... Relinquishment From UAB Health System Patient Safety Organization AGENCY: Agency for Healthcare Research and... relinquishment from the UAB Health System Patient Safety Organization of its status as a Patient......
Nils Gutacker; Luigi Siciliani; Giuseppe Moscelli; Hugh Gravelle
Many health care systems collect and disseminate information on provider quality in order to facilitate patient choice and induce competitive behaviour amongst providers. The Department of Health in England has recently mandated the collection of patient-reported health outcome measures (PROMs) for the purpose of performance assessment and consumer information. This is the first attempt to routinely measure the gain in health that patients experience as the result of care and thus offer a mor...
Kalckreuth, Sophie; Trefflich, Friederike; Rummel-Kluge, Christine
Background: The Internet is of great importance in today’s health sector, as most Internet users utilize online functions for health related purposes. Concerning the mental health care sector, little data exist about the Internet use of psychiatric patients. It is the scope of this current study to analyze the quantity and pattern of Internet usage among mental health patients. Methods: Patients from all services of the Department of Psychiatry at a university hospital were surveyed by comple...
Wald, J. S.
Summary Objectives Address current topics in consumer health informatics. Methods Literature review. Results Current health care delivery systems need to be more effective in the management of chronic conditions as the population turns older and experiences escalating chronic illness that threatens to consume more health care resources than countries can afford. Most health care systems are positioned poorly to accommodate this. Meanwhile, the availability of ever more powerful and cheaper information and communication technology, both for professionals and consumers, has raised the capacity to gather and process information, communicate more effectively, and monitor the quality of care processes. Conclusions Adapting health care systems to serve current and future needs requires new streams of data to enable better self-management, improve shared decision making, and provide more virtual care. Changes in reimbursement for health care services, increased adoption of relevant technologies, patient engagement, and calls for data transparency raise the importance of patient-generated health information, remote monitoring, non-visit based care, and other innovative care approaches that foster more frequent contact with patients and better management of chronic conditions. PMID:25123739
Antheunis, M.L.; Tates, K.; Nieboer, T.E.
OBJECTIVE: To investigate patients' and health professionals' (a) motives and use of social media for health-related reasons, and (b) barriers and expectations for health-related social media use. METHODS: We conducted a descriptive online survey among 139 patients and 153 health care professionals
Edwards Michelle; Wood Fiona; Davies Myfanwy; Edwards Adrian
Abstract Background Inadequate health literacy has been associated with poor management of long-term health conditions and has been identified as a key social determinant of health outcomes. However, little is understood about how health literacy might develop over time or the processes by which people may become more health literate. Our objectives were to describe how patients with a long-term condition practice health literacy in the management of their health and communication with health...
Vaart, van der R.
The role of the Internet in health care is increasing. Especially in the care for patients with chronic diseases eHealth offers many opportunities to empower patients in their own treatment, by providing them online self-management tools. The research in this thesis focusses on the use of eHealth in
Chen, Jie; Mullins, C. Daniel; Novak, Priscilla; Thomas, Stephen B.
Designing culturally sensitive personalized interventions is essential to sustain patients' involvement in their treatment and encourage patients to take an active role in their own health and health care. We consider patient activation and empowerment as a cyclical process defined through patient accumulation of knowledge, confidence, and…
Klein-Fedyshin, Michele S
Consumer Health Informatics (CHI) means different things to patients, health professionals, and health care systems. A broader perspective on this new and rapidly developing field will enable us to understand and better apply its advances. This article provides an overview of CHI discussing its evolution and driving forces, along with advanced applications such as Personal Health Records, Internet transmission of personal health data, clinical e-mail, online pharmacies, and shared decision-making tools. Consumer Health Informatics will become integrated with medical care, electronic medical records, and patient education to impact the whole process and business of health care. PMID:12238015
U.S. Department of Health & Human Services — OASIS C Based Home Health Agency Patient Outcome, Process and Potentially Avoidable Event Reports This report includes the state mean values for all measures...
Dişsiz, Gülçin; Yilmaz, Medine
The aim was to determine health literacy and the use of complementary and alternative therapies (CATs) in patients with cancer and to investigate the relationship between CAT usage and health literacy. The study cohort consisted of 250 oncology patients. The Patient Interview Form and the Adult Literacy in Medicine Scale were used for collecting data. The use of at least one CAT was reported by 24% of the patients surveyed. Herbal therapies (32.6%) constituted the most popular method, and the most popular herbal therapy was Nigella sativa (54.6%). A total of 29.8% of the patients using CATs reported using herbal therapies for an enhanced immune system. Illiterate patients and those who live in rural areas/towns displayed low levels of health literacy. Healthcare professionals should investigate patients' use of complementary and alternative approaches, and health literacy should be improved so that patients can be informed regarding the possible benefits and disadvantages of CATs. PMID:27157956
... https://medlineplus.gov/news/fullstory_160304.html Health Insurance Status May Affect Cancer Patients' Survival 2 studies highlight disparities in outcomes for uninsured and Medicaid patients To use the sharing features on this ...
Significant numbers of adults, when presented with basic health care information, have been shown to struggle with their abilities to comprehend and integrate materials presented to them. This lack of perception underscores the essence of health literacy. Even though health literacy is a newer concept, its impact is gathering momentum, as politicians, health care providers, researchers, and the media become more aware of the extent this disparity is seen within the health care system and how it affects patient care. This article explores how nursing philosophy and knowledge development have the capacity to provide a solid infrastructure that may promote increased health literacy among patients within the nonsurgical cosmetic arena. PMID:27254238
Lanham, Raymond; And Others
Health professionals tend to view dying patients with two intertwined attitudes. On one hand the patient possesses an irreversible pathological condition and the doctor is obliged to help that patient embrace death with as much dignity as possible. On the other hand, the patient's imminent death is daily testimony to the limits of the doctor's…
Frostholm, Lisbeth; Oernboel, Eva; Christensen, Kaj S;
follow-up for the whole group of patients. Patients presenting with MUS had more negative illness perceptions and lower mental and physical components subscale of the SF-36 scores at all time points. CONCLUSIONS: Patients' perception of a new or recurrent health problem predicts self-reported physical......OBJECTIVE: Little is known about whether illness perceptions affect health outcomes in primary care patients. The aim of this study was to examine if patients' illness perceptions were associated with their self-rated health in a 2-year follow-up period. METHODS: One thousand seven hundred eighty......-five primary care patients presenting a new or recurrent health problem completed an adapted version of the illness perception questionnaire and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) at baseline and 3, 12, and 24 months' follow-up. Linear regressions were performed for (1) all...
Lee, Vivian S; Miller, Thomas; Daniels, Chrissy; Paine, Marilynn; Gresh, Brian; Betz, A Lorris
Whether patient satisfaction scores can act as a catalyst for improving health care is highly debated. Some argue that pursuing patient satisfaction is overemphasized and potentially at odds with providing good care because it leads providers to overtest and overtreat patients and to bend to unreasonable patient demands, all to improve their ratings. Others cite studies showing that high patient satisfaction scores correlate with improved health outcomes. Ideally, assessing patient satisfaction metrics will encourage empathy, communication, trust, and shared decision making in the health care delivery process. From the patient's perspective, sharing such metrics motivates physicians to provide patient-centered care and meets their need for easily accessible information about their providers. In this article, the authors describe a seven-year initiative, which began in 2008, to change the culture of the University of Utah Health Care system to deliver a consistently exceptional patient experience. Five factors affected the health system's ability to provide such care: (1) a lack of good decision-making processes, (2) a lack of accountability, (3) the wrong attitude, (4) a lack of patient focus, and (5) mission conflict. Working groups designed initiatives at all levels of the health system to address these issues. What began as a patient satisfaction initiative evolved into a model for physician engagement, values-based employment practices, enhanced professionalism and communication, reduced variability in performance, and improved alignment of the mission and vision across hospital and faculty group practice teams. PMID:26606723
Full Text Available Abstract Background There is evidence for higher morbidity among prison inmates than in the general population. Despite this, patient satisfaction with the prison health services is scarcely investigated. The aim of the present study was to investigate patient satisfaction with prison health services in Norway and to analyze possible patient and service effects. Methods The survey took part in 29 prisons in the southern and central part of Norway, representing 62% of the total prison capacity in Norway. A total of 1,150 prison inmates with prison health services experiences completed a satisfaction questionnaire (90% response rate. The patients' satisfaction was measured on a 12-item index. Multilevel analyses were used to analyze both patient and service characteristics as predictors of satisfaction. Results The study revealed high levels of dissatisfaction with prison health services. There were substantial differences between services, with between-service-variance accounting for 9% of the total variance. Satisfaction was significantly associated with a senior staff member's evaluation of the health services possessing adequate resources and the quality of drug abuse treatment. At the patient level, satisfaction was significantly associated with older age, frequent consultations and better self-perceived health. Conclusion Prison inmates' satisfaction with the health services provided are low compared with patient satisfaction measured in other health areas. The substantial differences observed between services - even when adjusting for several known factors associated with patient satisfaction - indicate a potential for quality improvement.
Mohammadi, Zahra; Tehrani Banihashemi, Arash; Asgharifard, Homa; Bahramian, Mehran; Baradaran, Hamid Reza; Khamseh, Mohammad E.
Background: Health literacy is the ability to obtain, read, understand and use healthcare information to make appropriate health decisions and follow instructions for treatment. The aim of this study was to identify the effect of various factors on health literacy in patients with diabetes. Methods: 407 patients with diabetes older than 15 years of age were identified from the Diabetes Clinic affiliated to the Institute of Endocrinology and Metabolism (IEM) of Iran University of Medical Scien...
Nissen, Nina Konstantin; Madsen, Mette; Olsen Zwisler, Ann-Dorthe
AIMS: Relatives of heart patients experience anxiety, uncertainty, and low quality of life, and the hospitalization of a heart patient is associated with increased risk of death for the partner. Relatives' physical and mental problems may be rectified by activities established by the health...... interventions testing health service activities for relatives of heart patients, and one literature review scrutinized earlier studies within the field. All the interventions indicate positive effects on patients' and/or relatives' health and well-being, in accordance with nurses' assessments. Nevertheless, the...... services to support relatives and to enable them to handle the situation. This study systematically reviewed the literature on the latest health service interventions targeting relatives of heart patients. METHODS: The literature about interventions targeting relatives of heart patients has been...
Bitzer, Eva Maria; Spörhase, U
Medical rehabilitation in Germany has a long tradition. It is covered by the statutory sickness funds and pension schemes, and is aimed at the prevention of work disability and need for nursing care due to chronic conditions. Chronically ill but health-literate patients - patients capable of making good health-related decisions, or of participating strongly in this decision making - have better health outcomes. To enhance health literacy and participation, medical rehabilitation relies heavily on patient education. This article describes health literacy from the perspective of educational research, outlines the basics of learning principles, and draws conclusions for developing patient education programmes in medical rehabilitation. Implementing a constructivist learning paradigm promotes changes within the trainer team and within the rehabilitation institution - turning it into a health-literate health care organisation. Health literacy in medical rehabilitation is aimed at neither turning the patient into a physician nor replacing evidence-based recommendations through subjective preferences. Medical rehabilitation reaches patients best by using modern health education programmes based on findings from education research, theoretically founded and directed towards building competencies. Furthermore, an educationally qualified training team and a rehabilitation institution are essential in enabling formal and informal learning processes. PMID:26153473
Du, Hong-Sheng; Ma, Jing-Jian; Li, Mu
Objective: High-quality information provision can allow stroke patients to effectively participate in healthcare decision-making, better manage the stroke, and make a good recovery. In this study, we reviewed information needs of stroke patients, methods for providing information to patients, and considerations needed by the information providers. Data Sources: The literature concerning or including information provision for patients with stroke in English was collected from PubMed published from 1990 to 2015. Study Selection: We included all the relevant articles on information provision for stroke patients in English, with no limitation of study design. Results: Stroke is a major public health concern worldwide. High-quality and effective health information provision plays an essential role in helping patients to actively take part in decision-making and healthcare, and empowering them to effectively self-manage their long-standing chronic conditions. Different methods for providing information to patients have their relative merits and suitability, and as a result, the effective strategies taken by health professionals may include providing high-quality information, meeting patients’ individual needs, using suitable methods in providing information, and maintaining active involvement of patients. Conclusions: It is suggested that to enable stroke patients to access high-quality health information, greater efforts need to be made to ensure patients to receive accurate and current evidence-based information which meets their individual needs. Health professionals should use suitable information delivery methods, and actively involve stroke patients in information provision. PMID:27569241
Conclusions Patients and HCPs welcomed the introduction of agent technology to the delivery of health care. Widespread use will depend more on the trust patients place in their own GP than on technological issues.
Rustad Åse-Bente; Bjørngaard Johan; Kjelsberg Ellen
Abstract Background There is evidence for higher morbidity among prison inmates than in the general population. Despite this, patient satisfaction with the prison health services is scarcely investigated. The aim of the present study was to investigate patient satisfaction with prison health services in Norway and to analyze possible patient and service effects. Methods The survey took part in 29 prisons in the southern and central part of Norway, representing 62% of the total prison capacity...
Samuel G Smith
Full Text Available OBJECTIVE: There is ongoing debate on whether health literacy represents a skill-based construct for health self-management, or if it also more broadly captures personal 'activation' or motivation to manage health. This research examines 1 the association between patient activation and health literacy as they are most commonly measured and 2 the independent and combined associations of patient activation and health literacy skills with physical and mental health. METHODS: A secondary analysis of baseline cross-sectional data from the LitCog cohort of older adults was used. Participants (n = 697 were recruited from multiple US-based health centers. During structured face-to-face interviews, participants completed the Test of Functional Health Literacy in Adults (TOFHLA, the Patient Activation Measure (PAM, the SF-36 physical health summary subscale, and Patient Reported Outcomes Measurement Information Service (PROMIS short form subscales for depression and anxiety. RESULTS: The relationship between health literacy and patient activation was weak, but significant (r = 0.11, p<0.01. In models adjusted for participant characteristics, lower health literacy was associated with worse physical health (β = 0.13, p<0.001 and depression (β = -0.16, p<0.001. Lower patient activation was associated with worse physical health (β = 0.19, p<0.001, depression (β = -0.27, p<0.001 and anxiety (β-0.24, p<0.001. CONCLUSIONS: The most common measures of health literacy and patient activation are weakly correlated with each other, but also independently correlated with health outcomes. This suggests health literacy represents a distinct skill-based construct, supporting the Institute of Medicine's definition. Deficits in either construct could be useful targets for behavioral intervention.
Schadé Annemiek; van Grootheest Gerard; Smit Johannes H
Abstract Objectives HIV-infected patients are at increased risk of developing mental health symptoms, which negatively influence the treatment of the HIV-infection. Mental health problems in HIV-infected patients may affect public health. Psychopathology, including depression and substance abuse, can increase hazardous sexual behaviour and, with it, the chance of spreading HIV. Therefore, it is important to develop an optimal treatment plan for HIV-infected patients with mental health problem...
Hosek, Susan D
As a step toward improving its health information technology (IT) interoperability, the Military Health System is seeking to develop a research roadmap to better coordinate health IT research efforts, address IT capability gaps, and reduce programmatic risk for its enterprise projects. This report identifies gaps in research, policy, and practice involving patient privacy, consent, and identity management that need to be addressed to improve the quality and efficiency of care through health information exchange.
A.P. den Exter (André)
textabstractIn a new case on patients seeking medical services abroad, the Leichtle case, the European Court of Justice (ECJ) confirmed its previous rulings on patient mobility. According to the Court, patients in the European Union have a (conditional) right to receive health care
Ballard, Deborah; Hill, Jill
Patients with cancer are often faced with complex diagnoses that require decision making in a highly stressful environment. The role of the healthcare team is to ensure that patients have the information, tools, and resources needed to make informed decisions. However, low health literacy is a common and undervalued factor in the outcomes of patients, particularly those with cancer. PMID:27206288
Long, Jie; Hulse, Nathan C.; Tao, Cui
Infobuttons have proven to be an important element in modern electronic health records (EHR), providing educational materials to both providers and patients. However, the usage of infobuttons in personalized health records (PHR) is only lightly documented in the literature. Patient-facing infobuttons pose a new challenge because patients have different questions and educational levels than professional users in EHRs. In this paper, we present usage data for patient-facing infobuttons that have recently been integrated in Intermountain Healthcare’s patient portal MyHealth. We summarize use patterns by usage classified in modules, electronic resources (eResource), and infobutton sessions. Based on the analysis, we propose further enhancements to the current implementation of infobuttons in MyHealth. PMID:26306251
Green, Carla A; Perrin, Nancy A; Polen, Michael R; Leo, Michael C; Hibbard, Judith H; Tusler, Martin
Our objective was to adapt the physical health Patient Activation Measure (PAM) for use among people with mental health conditions (PAM-MH). Data came from three studies among people with chronic mental health conditions and were combined in Rasch analyses. The PAM-MH's psychometric properties equal those of the original 13-item PAM. Test-retest reliability and concurrent validity were good, and the PAM-MH showed sensitivity to change. The PAM-MH appears to be a reliable and valid measure of patient activation among individuals with mental health problems. It appears to have potential for use in assessing change in activation. PMID:19728074
Maharaj, Breminand; Vayej, Ahmed C
In order to determine whether adequate attention is paid to the maintenance of good oral health in patients at risk of developing infective endocarditis, we studied 44 black patients with severe rheumatic heart disease before they had cardiac surgery. Plaque and gingival index scores were calculated and panoramic radiographs were done in all patients. There were 17 males and 27 females (mean age: 30.6 years). The plaque and gingival index scores were classified as poor in 31.8 and 54.6% of patients, respectively. Panoramic radiographic findings included caries in 56.8% of patients, peri-apical pathology in 18.1% and retained roots in 22.7% of patients. This study demonstrates that inadequate attention is paid to the maintenance of good oral health in patients with severe rheumatic heart disease. The oral and dental care of patients at risk of developing infective endocarditis needs to be improved. PMID:22836156
Sameer Bhaskar GOKHALE
Full Text Available Low patient adherence remains a major public health challenge globally and imposes a considerable economic burden on healthcare systems. It is critical to develop an effective intervention to improve patient adherence. Factors such as physician-patient relation, patient's health literacy, attitude, cultural variations, and patient’s involvement in decision making are responsible for improving adherence. Information technology has revolutionized almost all industries including healthcare but its use has not shown its full promise to boost adherence. Recent developments in smart phone market penetration, gamification, and easy to navigate user experience have made it possible for healthcare providers to effectively connect with patients using innovative ways enabled by technology. Leveraging on this fact, healthcare industry should be focusing on development and use of interactive health games. Indication-wise games can be developed in collaboration with physicians, academics, thought leaders and experienced media companies. In summary, gamification mayeffectively be used to improve patient adherence.
Marshall, J G; Haynes, R B
Many librarians take an active role in patient education, for practical and ethical reasons; however, it is important to examine the effect of such activities on health outcomes. Although the rationale for patient education is that increased knowledge leads to a change in attitude that in turn affects behavior, studies have shown that this is not always true. Furthermore, other studies have shown that patient education programs by themselves have no lasting influence on patient compliance wit...
Xianchai Lin; Mei Wang; Yajing Zuo; Mingge Li; Xiaofeng Lin; Siping Zhu; Yongxin Zheng; Minbin Yu; Lamoureux, Ecosse L.
PURPOSE: The aim of the study was to assess levels of health literacy and computer skills in Chinese patients with cataract, and their impact on the doctor-patient relationship. METHODS: We undertook a cross-sectional study of cataract patients scheduled for cataract extraction procedures in Guangdong Province, China. Generic health literacy was assessed using 3 established screening questions. Adequate computer skills was determined if patients had used a computer and routinely used search e...
Birkeland, Soren; Gildberg, Frederik A
Coercive mechanical restraint (MR) in psychiatry constitutes the perhaps most extensive exception from the common health law requirement for involving patients in health care decisions and achieving their informed consent prior to treatment. Coercive measures and particularly MR seriously collide with patient autonomy principles, pose a particular challenge to psychiatric patients' legal rights, and put intensified demands on health professional performance. Legal rights principles require rationale for coercive measure use be thoroughly considered and rigorously documented. This article presents an in-principle Danish Psychiatric Complaint Board decision concerning MR use initiated by untrained staff. The case illustrates that, judicially, weight must be put on the patient perspective on course of happenings and especially when health professional documentation is scant, patients' rights call for taking notice of patient evaluations. Consequently, if it comes out that psychiatric staff failed to pay appropriate consideration for the patient's mental state, perspective, and expressions, patient response deviations are to be judicially interpreted in this light potentially rendering MR use illegitimated. While specification of law criteria might possibly improve law use and promote patients' rights, education of psychiatry professionals must address the need for, as far as possible, paying due regard to meeting patient perspectives and participation principles as well as formal law and documentation requirements. PMID:27123152
Tavares, Jorge; De Oliveira, Tiago
Background The future of health care delivery is becoming more citizen centered, as today’s user is more active, better informed, and more demanding. Worldwide governments are promoting online health services, such as electronic health record (EHR) patient portals and, as a result, the deployment and use of these services. Overall, this makes the adoption of patient-accessible EHR portals an important field to study and understand. Objective The aim of this study is to understand the factors ...
Lundgaard, Mette; Rabøl, Louise; Jensen, Elisabeth Agnete Brøgger;
This paper describes the process that lead to the passing of the Act for Patient Safety in the Danisk health care sytem, the contents of the act and how the act is used in the Danish health care system. The act obligates frontline health care personnel to report adverse events, hospital owners to...... act on the reports and the National Board of Health to commuicate the learning nationally. The act protects health care providers from sanctions as a result of reporting. In January 2004, the Act on Patient Safety in the Danish health care system was put into force. In the first twelve months 5740...... adverse events were reported. the reports were analyzed locally (hospital and region), anonymized ad then sent to the National Board af Health. The Act on Patient Safety has driven the work with patient safety forward but there is room for improvement. Continuous and improved feedback from all parts of...
Singh, Hardeep; Sittig, Dean F
Health information technology (health IT) has potential to improve patient safety but its implementation and use has led to unintended consequences and new safety concerns. A key challenge to improving safety in health IT-enabled healthcare systems is to develop valid, feasible strategies to measure safety concerns at the intersection of health IT and patient safety. In response to the fundamental conceptual and methodological gaps related to both defining and measuring health IT-related patient safety, we propose a new framework, the Health IT Safety (HITS) measurement framework, to provide a conceptual foundation for health IT-related patient safety measurement, monitoring, and improvement. The HITS framework follows both Continuous Quality Improvement (CQI) and sociotechnical approaches and calls for new measures and measurement activities to address safety concerns in three related domains: 1) concerns that are unique and specific to technology (e.g., to address unsafe health IT related to unavailable or malfunctioning hardware or software); 2) concerns created by the failure to use health IT appropriately or by misuse of health IT (e.g. to reduce nuisance alerts in the electronic health record (EHR)), and 3) the use of health IT to monitor risks, health care processes and outcomes and identify potential safety concerns before they can harm patients (e.g. use EHR-based algorithms to identify patients at risk for medication errors or care delays). The framework proposes to integrate both retrospective and prospective measurement of HIT safety with an organization's existing clinical risk management and safety programs. It aims to facilitate organizational learning, comprehensive 360 degree assessment of HIT safety that includes vendor involvement, refinement of measurement tools and strategies, and shared responsibility to identify problems and implement solutions. A long term framework goal is to enable rigorous measurement that helps achieve the safety
... Reports from the National Medical Care Utilization and Expenditure Survey Clearinghouse on Health Indexes Statistical Notes for ... CNMs. Within CHCs, NPs and CNMs disproportionately served young women compared with patients served by physicians, a ...
Aim: The comparative study between in-centre haemodialysis (HD) and continuous ambulatory peritoneal dialysis (PD) patients regarding self-reported quality of life (QoL) as well as some psychological dimensions that may affect and may be affected by the patient’s state of health, like health locus of control beliefs, depression and anxiety. Material and Method: The sample consists of 144 patients in-centre haemodialysis or continuous ambulatory peritoneal dialysis (CAPD). Patient-reported ass...
Mills, Edward; Ernst, Edzard; Singh, Rana; Ross, Cory; Wilson, Kumanan
Background Many breast cancer patients use complementary and alternative medicine (CAM). We aimed to determine what advice health food store employees present to individuals seeking treatment options for breast cancer. Methods Eight data gatherers asked employees of all retail health food stores in a major Canadian city, what they recommended for a patient with breast cancer. The data gatherers inquired about product safety, potential drug interactions, costs and efficacy. They also enquired ...
Raine, R.; Lewis, L.; Sensky, T; Hutchings, A; Hirsch, S; Black, N.
BACKGROUND: A large proportion of a general practitioner's (GP's) caseload comprises patients with mental health problems. It is important to ensure that care is provided appropriately, on the basis of clinical need. It is therefore necessary to investigate the determinants of the use of mental health care in the primary care sector and, in particular, to identify any non-clinical characteristics of patients that affect the likelihood of their receiving appropriate care. AIM: To identify and ...
Suzuki, Mari Hotta
Osteoporosis associated with anorexia nervosa (AN) is common, and tends to be severe, slow to recover from, and sometimes irreversible. The abnormal bone metabolism in severely emaciated AN patients involves both a reduction in bone formation and an increase in bone resorption. The annual change in lumbar bone mineral density (BMD) is significantly correlated with BMI at the entry. The critical BMI for a positive increase in BMD was 16.4±0.3 kg/m(2). Nutritional improvement with body weight gain is the most important goal of treatment for AN-related osteoporosis since it increases both serum levels of insulin-like growth factor-I, a potent osteogenic factor, and estradiol, a powerful bone resorption inhibitor. However, it is difficult for AN patients to accept weight gain. About 50% of AN patients are insufficient of vitamin D and 43% show an increase in plasma undercalboxylated osteocalcin, indicating a deficiency state of the vitamin K(2). Vitamin D(3) or vitamin K(2) (menatetrenone) can prevent further bone loss in severely emaciated AN patients. Recently, bone strength has been evaluated by both BMD and bone quality. Plasma levels of homocysteine, a marker of degradation of bone quality, have significantly positive correlation with their ages of AN patients. We must evaluate bone density as well as bone quality in AN patients. PMID:23354095
Goss, Claudia; Renzi, Cristina
In recent years there has been a growing recognition in Western healthcare systems of the importance of considering preferences of patients and the public in tailoring health services and treatment plans. The active collaboration between doctor and patient has recently been encouraged through the shared decision-making model. Aim of the present contribution is to describe the current state of patient and public participation in healthcare in Italy. First, we will briefly outline the organization of the Italian National Health Service; second, we will describe the governmental and institutional initiatives regarding participation; third, some examples of associations and initiatives promoting patient participation will be provided; forth, we will report on research projects on patient participation published in peer-reviewed journals; and finally, we will provide some examples on training activities promoting patient participation. The Italian National Health Plan and many regional and local health authorities in Italy explicitly recognize the importance of patient/citizen participation in healthcare decisions at the macro, meso and micro level of decision-making. However, application of a shared model is still at an early stage in Italy. The reported experiences have yielded positive results and have shown that particular attention should be dedicated to more disadvantaged subgroups of the population, involving patient organisations, enhancing patient/citizen knowledge and adopting approaches that take the specific context into account. PMID:17601178
Jonker, E.J.; Goossens, P.J.J.; Steenhuis, I.H.; Oud, N.E.
Mental health nurses are faced with an increasing number of aggressive incidents during their daily practice. The coercive intervention of seclusion is often used to manage patient aggression in the Netherlands. However, GGZ Nederland, the Dutch association of service providers for mental health and
Southern African HIV Clinicians Society
These guidelines are intended as a reference document to assist HIV nurse and doctor clinicians in managing mental health disorders. It is intended to improve awareness, knowledge and capacity to support patients living with HIV and mental health disorders.
Southern African HIV Clinicians Society
Full Text Available These guidelines are intended as a reference document to assist HIV nurse and doctor clinicians in managing mental health disorders. It is intended to improve awareness, knowledge and capacity to support patients living with HIV and mental health disorders.
Venuta, Rosa; Graham, Ian D
The Canadian Institutes of Health Research's (CIHR), Canada's premier health research funding agency, is moving forward in realizing a more systematic, ongoing integration of citizens' input in priority setting, governance and funding programs and tools. In 2008, the Canadian Institutes of Health Research (CIHR) developed a Framework for Citizen Engagement. This Framework establishes guidelines for implementing a more systematic approach to consulting and engaging citizens, such as in assessing the merit and relevance of research applications, developing strategic plans, setting research priorities and for strengthening their role on CIHR's governance committees. This paper describes the current context for public consultation in Canada's federal health care system, the new CIHR citizen engagement framework and discusses citizen engagement activities and efforts undertaken by CIHR institutes and branches. It reviews the methods used by CIHR to engage citizens in four key focus areas: 1. Representation on CIHR's Boards and Committees; 2. Corporate and Institute strategic plans, priorities, policies, and guidelines; 3. Research priority setting and integrated knowledge translation; 4. Knowledge dissemination and public outreach. In discussing CIHR's experiences, the paper identifies some of the challenges and benefits of engaging citizens in CIHR's research processes, including participating in decision making and informing strategic priorities. PMID:20539148
Full Text Available Multiple sclerosis (MS is a gait disorder characterized by acute episodes of neurological defects leading to progressive disability. Patients with MS have multiple risk factors for osteoporotic fractures, such as progressive immobilization, long-term glucocorticoids (GCs treatment or vitamin D deficiency. The duration of motor disability appears to be a major contributor to the reduction of bone strength. The long term immobilization causes a marked imbalance between bone formation and resorption with depressed bone formation and a marked disruption of mechanosensory network of tightly connected osteocytes due to increase of osteocyte apoptosis. Patients with higher level of disability have also higher risk of falls that combined with a bone loss increases the frequency of bone fractures. There are currently no recommendations how to best prevent and treat osteoporosis in patients with MS. However, devastating effect of immobilization on the skeleton in patients with MS underscores the importance of adequate mechanical stimuli for maintaining the bone structure and its mechanical competence. The physical as well as pharmacological interventions which can counteract the bone remodeling imbalance, particularly osteocyte apoptosis, will be promising for prevention and treatment of osteoporosis in patients with MS.
Full Text Available Background: Knowledge of correct information-seeking behavior by the patients can provide health specialists and health information specialists with valuable information in improving health care. This study aimed to investigate the passive receipt and active seeking of health information by diabetic patients. Materials and Methods: A survey method was used in this research on 6426 diabetic patients of whom 362 patients were selected by a no percentage stratified random sampling. The Longo information-seeking behavior questionnaire was used to collect data and they were analyzed by SPSS 20 software. Results: The most common information source by diabetic patients was practitioners (3.12. The minimum usage among the information sources were from charity organizations and emergency phone lines with a usage of close to zero. The amount of health information gained passively from each source has the lowest average of 4.18 and usage of this information in making health decision has the highest average score of 5.83. Analysis of the data related to active seeking of information showed that knowledge of available medical information from each source has the lowest average score of 3.95 and ability in using the acquired information for making medical decisions has the highest average score of 5.28. The paired t-test showed that differences between passive information receipt (41.68 and active information seeking (39.20 considered as statistically significant (P < 0.001. Conclusion: Because diabetic patients are more passive information receivers than active information seekers, the health information must be distributed by passive means to these patients. In addition, information-seeking behavior during different time periods should be investigated; to identify more effective distribution of health information.
Schiffer, Angélique A; Denollet, Johan; Pedersen, Susanne S.; Broers, Herman; Widdershoven, Jos W
Cardiac resynchronization therapy (CRT) is a promising treatment in chronic heart failure (CHF). However, a subgroup of patients still report impaired health status, cardiac symptoms, and feelings of disability following CRT. The aims of this study were to examine (1) whether CHF patients treated...
Ntabaye, M K; Scheutz, F; Poulsen, S
Emergency oral health care, as conceived in Tanzania, is an on-demand service provided at a rural health center or dispensary by a Rural Medical Aide. The service includes: simple tooth extraction under local anesthesia, draining of abscesses, control of acute oral infection with appropriate drug therapy, first aid for maxillo-facial trauma, and recognition of oral conditions requiring patient referral for further care at the district or regional hospital dental clinic. The objective of the present study was to describe patient satisfaction with emergency oral health care services in rural Tanzania and determine the relative importance of factors influencing patient satisfaction. The study was carried out as a cross-sectional interview survey between April 1993 and May 1994 using a patient satisfaction questionnaire in rural villages in the Rungwe district of Tanzania. It included 206 patients aged 18 years or more who had received emergency oral health care between April 1993 and March 1994. Overall, 92.7% of the respondents reported that they were satisfied with the service. Patients who were married, had no formal education and lived more than 3 km from the dispensary were more likely to be satisfied with treatment. In a logistic regression model, a good working atmosphere at the dispensary, a good relationship between care provider and patients (art of care) and absence of post-treatment complications significantly influenced patient satisfaction with odds ratios of 10.3, 17.4 and 6.2, respectively. PMID:9792119
Peters, J.B.; Rijssenbeek-Nouwens, L.H.; Bron, A.O.; Fieten, K.B.; Weersink, E.J.; Bel, E.H.; Vercoulen, J.H.M.M.
BACKGROUND: Patients with severe asthma experience problems in different areas of their health status. Identification of these areas will provide insight in the patients needs and perhaps what determines the burden of disease. The Nijmegen Clinical Screening Instrument (NCSI) was recently developed
Trevithick, Liam; Painter, Jon; Keown, Patrick
Aims and method This paper investigates the relationship between cluster (Mental Health Clustering Tool, MHCT) and diagnosis in an in-patient population. We analysed the diagnostic make-up of each cluster and the clinical utility of the diagnostic advice in the Department of Health’s Mental Health Clustering Booklet. In-patients discharged from working-age adult and older people’s services of a National Health Service trust over 1 year were included. Cluster on admission was compared with pri...
Adams, Robert John
A central plank of health care reform is an expanded role for educated consumers interacting with responsive health care teams. However, for individuals to realize the benefits of health education also requires a high level of engagement. Population studies have documented a gap between expectations and the actual performance of behaviours related to participation in health care and prevention. Interventions to improve self-care have shown improvements in self-efficacy, patient satisfaction, coping skills, and perceptions of social support. Significant clinical benefits have been seen from trials of self-management or lifestyle interventions across conditions such as diabetes, coronary heart disease, heart failure and rheumatoid arthritis. However, the focus of many studies has been on short-term outcomes rather that long term effects. There is also some evidence that participation in patient education programs is not spread evenly across socio economic groups. This review considers three other issues that may be important in increasing the public health impact of patient education. The first is health literacy, which is the capacity to seek, understand and act on health information. Although health literacy involves an individual's competencies, the health system has a primary responsibility in setting the parameters of the health interaction and the style, content and mode of information. Secondly, much patient education work has focused on factors such as attitudes and beliefs. That small changes in physical environments can have large effects on behavior and can be utilized in self-management and chronic disease research. Choice architecture involves reconfiguring the context or physical environment in a way that makes it more likely that people will choose certain behaviours. Thirdly, better means of evaluating the impact of programs on public health is needed. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework has been
Bakke, Merete; Larsen, Stine L; Lautrup, Caroline;
No comprehensive study has previously been published on orofacial function in patients with well-defined Parkinson's disease (PD). Therefore, the aim of this study was to perform an overall assessment of orofacial function and oral health in patients, and to compare the findings with matched......-matched controls. Orofacial function and oral health were assessed using the Nordic Orofacial Test, masticatory ability, performance and efficiency, oral stereognosis, jaw opening, jaw muscle tenderness, the Oral Health Impact Profile-49, number of natural teeth, and oral hygiene. Orofacial dysfunction was more...... prevalent, mastication and jaw opening poorer, and impact of oral health on daily life more negative, in patients with PD than in controls. The results indicate that mastication and orofacial function are impaired in moderate to advanced PD, and with progression of the disease both orofacial and dental...
Fairfield, G.; Hunter, D.J.; Mechanic, D.; Rosleff, F.
The rhetoric and realities of managed care are easily confused. The rapid growth of managed care in the United States has had many implications for patients, doctors, employers, state and federal programmes, the health insurance industry, major medical institutions, medical research, and vulnerable patient populations. It has restricted patients' choice of doctors and limited access to specialists, reduced the professional autonomy and earnings of doctors, shifted power from the non-profit to...
Ford, R C; Bach, S A; Fottler, M D
Patient perceptions of the quality of services provided is a key factor (along with cost effectiveness) in determining a health care organization's competitive advantage and survival. This article examines the advantages, disadvantages, and problems associated with nine different methods of measuring patient satisfaction with service quality. The appropriateness of each of these techniques under different organizational conditions is also discussed. The article concludes with guidelines for measurement of patient satisfaction and implementation of managerial follow-up. PMID:9143904
Ruberton, PM; Huynh, HP; Miller, TA; Kruse, E.; Chancellor, J; Lyubomirsky, S
Cultural portrayals of physicians suggest an unclear and even contradictory role for humility in the physician-patient relationship. Despite the social importance of humility, however, little empirical research has linked humility in physicians with patient outcomes or the characteristics of the doctor-patient visit. The present study investigated the relationship between physician humility, physician-patient communication, and patients' perceptions of their health during a planned medical vi...
Weiner Jonathan P
Full Text Available Abstract The digital revolution will have a profound impact on how physicians and health care delivery organizations interact with patients and the community at-large. Over the coming decades, face-to-face patient/doctor contacts will become less common and exchanges between consumers and providers will increasingly be mediated by electronic devices. In highly developed health care systems like those in Israel, the United States, and Europe, most aspects of the health care and consumer health experience are becoming supported by a wide array of technology such as electronic and personal health records (EHRs and PHRs, biometric & telemedicine devices, and consumer-focused wireless and wired Internet applications. In an article in this issue, Peleg and Nazarenko report on a survey they fielded within Israel's largest integrated delivery system regarding patient views on the use of electronic communication with their doctors via direct-access mobile phones and e-mail. A previous complementary paper describes the parallel perspectives of the physician staff at the same organization. These two surveys offer useful insights to clinicians, managers, researchers, and policymakers on how best to integrate e-mail and direct-to-doctor mobile phones into their practice settings. These papers, along with several other recent Israeli studies on e-health, also provide an opportunity to step back and take stock of the dramatic impact that information & communication technology (ICT and health information technology (HIT will have on clinician/patient communication moving forward. The main goals of this commentary are to describe the scope of this issue and to offer a framework for understanding the potential impact that e-health tools will have on provider/patient communication. It will be essential that clinicians, managers, policymakers, and researchers gain an increased understanding of this trend so that health care systems around the globe can adapt, adopt
Multiple sclerosis (MS) is a gait disorder characterized by acute episodes of neurological defects leading to progressive disability. Patients with MS have multiple risk factors for osteoporotic fractures, such as progressive immobilization, long-term glucocorticoids (GCs) treatment or vitamin D deficiency. The duration of motor disability appears to be a major contributor to the reduction of bone strength. The long term immobilization causes a marked imbalance between bone formation and reso...
Maria Vladimirovna Sklyanova
Full Text Available Gout is a systemic tophaceous disease that is becoming more and more prevalent. If untreated or poorly managed, gout can result in disability. The possible reason for inadequate gout control may be that the primary care physicians are unaware of diagnostic criteria and clinical guidelines for the management of these patients and diagnostic errors. Objective: to estimate the level of gout knowledge in primary care physicians. Subjects and methods. Fifty Irkutsk local therapists were questioned. A specially developed anonymous questionnaire included items on sex, age, work experience, and the principles of gout diagnosis and treatment. Results. Only 42% of the therapists know that the gold standard for diagnosis of gout is identification of monosodium urate crystals by polarizing microscopy. Only 6% of the therapists use the Wallace classification criteria for the early diagnosis of gout. 56 % of the physicians consider it possible to prescribe allopurinol in the acute period of the disease 26% think that allopurinol intake can be stopped after normouricemia is achieved; 10% of the physicians do not prescribe allopurinol for gout patients. These widespread errors lead to worsening arthritis and a negative attitude of patients towards allopurinol treatment in future. Conclusion. The findings suggest that the level of gout knowledge should be increased in primary care physicians.
Maria Vladimirovna Sklyanova
Full Text Available Gout is a systemic tophaceous disease that is becoming more and more prevalent. If untreated or poorly managed, gout can result in disability. The possible reason for inadequate gout control may be that the primary care physicians are unaware of diagnostic criteria and clinical guidelines for the management of these patients and diagnostic errors. Objective: to estimate the level of gout knowledge in primary care physicians. Subjects and methods. Fifty Irkutsk local therapists were questioned. A specially developed anonymous questionnaire included items on sex, age, work experience, and the principles of gout diagnosis and treatment. Results. Only 42% of the therapists know that the gold standard for diagnosis of gout is identification of monosodium urate crystals by polarizing microscopy. Only 6% of the therapists use the Wallace classification criteria for the early diagnosis of gout. 56 % of the physicians consider it possible to prescribe allopurinol in the acute period of the disease 26% think that allopurinol intake can be stopped after normouricemia is achieved; 10% of the physicians do not prescribe allopurinol for gout patients. These widespread errors lead to worsening arthritis and a negative attitude of patients towards allopurinol treatment in future. Conclusion. The findings suggest that the level of gout knowledge should be increased in primary care physicians.
Full Text Available Abstract Background Negative events are abusive, potentially dangerous or life-threatening health care events, as perceived by the patient. Patients' perceptions of negative events are regarded as a potentially important source of information about the quality of health care. We explored negative events in hospital care as perceived by immigrant patients. Methods Semi-structured individual and group interviews were conducted with respondents about negative experiences of health care. Interviews were transcribed and analyzed using a framework method. A total of 22 respondents representing 7 non-Dutch ethnic origins were interviewed; each respondent reported a negative event in hospital care or treatment. Results Respondents reported negative events in relation to: 1 inadequate information exchange with care providers; 2 different expectations between respondents and care providers about medical procedures; 3 experienced prejudicial behavior on the part of care providers. Conclusions We identified three key situations in which negative events were experienced by immigrant patients. Exploring negative events from the immigrant patient perspective offers important information to help improve health care. Our results indicate that care providers need to be trained in adequately exchanging information with the immigrant patient and finding out specific patient needs and perspectives on illness and treatment.
Full Text Available Background: Oral cav ity re flects the general health status of a person and diagnosing and treating oral manifestations of systemic disease pose a greater challenge. Even though there is strong evidence that supports the relationship between oral health and diabetes mellitus, oral health awareness is lacking among diabetic patients and health professionals. The present study was undertaken to determine the oral health status in type II diabetic patients and also to compare the oral changes in controlled diabetes and u ncontrolled diabetes. Materials and methods: Study population consists of 60 diabetic patients w hich is divided into 30 controlled and 30 uncontrolled diabetics; 60 healthy subjects. Each of these diabetic groups were again subdivided according to their duration as patients having a disease duration below 10 years 15 and patients having a disease duration above 10 years. 15 Various oral manifestations were examined and also CPI score and loss of attachment were recorded. Statistical analysis was done. Results: The most frequent oral signs and symptoms obser ved in both controlled and uncontrolled diabetic patients was perio dontitis followed by hyposalivation, taste dysfunction, halitosis, fissured tongue, burning mouth, angular cheilitis, ulcer and lichen planus. These oral manifestation showed an increase in distribution in diabetic patients when compared to nondia betic. Community periodo ntal index (CPI scores for assess ing periodontal status showed higher scores in diabetics than nondiabetics and also in uncontrolled diabetes than controlled diabetes. For periodontal s tatus assessment based on disease duration, patient with higher disease duration showed higher CPI scores than those with a lesser disease duration. Assess ment of loss of attachment in our study showed higher values in diabetic patients compared to healthy controls. Conclusion: From our present study, it was clear that oral manifestations in uncontrolled
Tariman, Joseph D; Gleason, Charise; Faiman, Beth; Doss, Deborah; Catamero, Donna; Bishop-Royse, Jessica; Katz, Mike; Kurtin, Sandra; Moran, Diane; Lonial, Sagar
Health maintenance (HM) practices are essential to prevent illness, promote well-being, and maximize health. Patients with multiple myeloma (MM) are at increased risk for cardiovascular disease and cancers, yet, research on HM practices and preventative care of MM survivors has limited report. The study comprised a descriptive, correlational, and cross-sectional online survey design. Survey of patients with MM was carried out through the International Myeloma Foundation (IMF) and the Association of Cancer Online Resources (ACOR) e-mail list services. The members of the IMF and ACOR e-mail list services were surveyed, of which 237 patients responded. The modified Medical Expenditure Preventive Survey-Preventive Care questionnaire was used; it included items that ask patients regarding their healthcare practices that relate to dental care, cancer prevention, addiction, lifestyles, sensory screening, immunizations, cardiovascular, endocrine, psychosocial, and bone health. Descriptive statistics, Pearson's chi-square, and Spearman's rho correlation coefficient were obtained. In this study, men had statistically significant inferior global health maintenance scores than women (P = 0.002). Being employed (P = 0.054) and married or partnered (P = 0.017) were significantly correlated with better health maintenance patterns among male respondents. In contrast, no statistically significant correlations between sociodemographic factors and health maintenance patterns were found in women. Patients with MM, particularly men, require continued education and close monitoring of health maintenance practices. These findings are consistent with publications looking at gender disparities in healthcare utilization in the United States. Studies show that men, in general, are less likely to seek preventative healthcare screenings. Healthcare providers must incorporate health maintenance promotion during clinic visits. PMID:27119422
Full Text Available Background: To date, mental health professionals’ attitudes toward posttraumatic stress disorder (PTSD, compared to other psychiatric disorders such as schizophrenia or depression, have rarely been studied. Objective: We assessed mental health professionals’ attitudes toward patients with PTSD compared to patients suffering from depression. Method: Case vignettes of a patient with either PTSD or depression were presented to two samples of mental health professionals: attendees of a conference on posttraumatic stress (N=226 or of a lecture for psychiatry residents (N=112. Participants subsequently completed a questionnaire that assessed their attitude reactions to the presented case. Results: Participants showed similarly positive attitudes toward depression and PTSD. PTSD elicited a more favorable attitude with regard to prosocial reactions, estimated dependency, attributed responsibility, and interest in the case, particularly in mental health professionals specializing in psychotraumatology. Across diagnoses, higher age and longer professional experience were associated with more positive attitudes toward patients. Conclusions: Mental health professionals’ positive attitudes toward patients with depression and PTSD correlate with their specific knowledge about the disorder, their level of professional training, and their years of professional experience. Limitations: The instruments used, although based on established theoretical concepts in attitude research, were not validated in their present versions.
Robert John Adams
Full Text Available Robert John AdamsThe Health Observatory, The Queen Elizabeth Hospital Campus, The University of Adelaide, Woodville, South Australia, AustraliaAbstract: A central plank of health care reform is an expanded role for educated consumers interacting with responsive health care teams. However, for individuals to realize the benefits of health education also requires a high level of engagement. Population studies have documented a gap between expectations and the actual performance of behaviours related to participation in health care and prevention. Interventions to improve self-care have shown improvements in self-efficacy, patient satisfaction, coping skills, and perceptions of social support. Significant clinical benefits have been seen from trials of self-management or lifestyle interventions across conditions such as diabetes, coronary heart disease, heart failure and rheumatoid arthritis. However, the focus of many studies has been on short-term outcomes rather that long term effects. There is also some evidence that participation in patient education programs is not spread evenly across socio economic groups. This review considers three other issues that may be important in increasing the public health impact of patient education. The first is health literacy, which is the capacity to seek, understand and act on health information. Although health literacy involves an individual’s competencies, the health system has a primary responsibility in setting the parameters of the health interaction and the style, content and mode of information. Secondly, much patient education work has focused on factors such as attitudes and beliefs. That small changes in physical environments can have large effects on behavior and can be utilized in self-management and chronic disease research. Choice architecture involves reconfiguring the context or physical environment in a way that makes it more likely that people will choose certain behaviours. Thirdly
Full Text Available Aim: The comparative study between in-centre haemodialysis (HD and continuous ambulatory peritoneal dialysis (PD patients regarding self-reported quality of life (QoL as well as some psychological dimensions that may affect and may be affected by the patient’s state of health, like health locus of control beliefs, depression and anxiety. Material and Method: The sample consists of 144 patients in-centre haemodialysis or continuous ambulatory peritoneal dialysis (CAPD. Patient-reported assessments included: a WHOQOL-BREF, b General Health Questionnaire (GHQ-28, c Multidimensional Health Locus of Control Questionnaire (MHLC, d State - Trait Anxiety Inventory (STAI I, II and e Center for Epidemiologic Studies Depression Scale (CES-D.Results: HD patients presented lower scores in WHOQOL-BREF domain of environment. Furthermore, they reported higher scores in the GHQ-28 sub-scales of anxiety/insomnia and severe depression as well as of the total score of the questionnaire. Regarding health beliefs, statistically significant difference was observed in HD patients, who presented higher scores in the internal health locus of control. Conclusions: Patients in HD treatment modality were experiencing a more compromised QoL indicating greater discontent with different aspects of their environment. Further, they reported more symptoms of anxiety, sleeping problems, depression or suicidal thoughts.
Eyüboğlu, Ezgi; Schulz, Peter J
Objective This study aimed to assess the impact of health literacy and patient empowerment on diabetes self-care behaviour in patients in metropolitan Turkish diabetes centres. The conceptual background is provided by the psychological health empowerment model, which holds that health literacy without patient empowerment comes down to wasting health resources, while empowerment without health literacy can lead to dangerous or suboptimal health behaviour. Design, setting and participants A cro...
Full Text Available To advocate for patients to be more actively involved with the healthcare services they receive, particularly patients living with chronic illness, the Faculty of Medicine of the University of Montreal and its affiliated hospitals developed the Patients as Partners concept where the patient is considered a full-fledged partner of the health care delivery team and the patient's experiential knowledge is recognized. This study aims to show how patients view their engagement with healthcare professionals regarding their direct care. Using theoretical sampling, 16 semi-structured interviews were conducted with patients with chronic illness who were familiar with the concept of Patients as Partners. Data analysis followed a constructivist grounded theory approach. Patients describe themselves as proactively engaging in three types of practice, regardless of health professionals' openness to their role as partners. The first is a process of continuous learning that allows them to acquire experiential knowledge about their health, as well as scientific information and technical know-how. The second involves their assessment of the healthcare they receive, in terms of its quality and how it aligns with their personal preferences. It includes their assessment of the quality of their relationship with the health professional and of the latter's scientific knowledge and technical know-how. The third type, adaptation practices, builds on patients' learning and assessments to compensate for and adapt to what has been perceived as optimal or non-optimal health or healthcare circumstances. Patients appear to play a more active and less docile role in their own direct care than suggested so far in the literature, regardless of the degree of reciprocity of the partnership or the degree to which the health professional seeks to encourage patient engagement.
Pomey, Marie-Pascale; Ghadiri, Djahanchah P; Karazivan, Philippe; Fernandez, Nicolas; Clavel, Nathalie
To advocate for patients to be more actively involved with the healthcare services they receive, particularly patients living with chronic illness, the Faculty of Medicine of the University of Montreal and its affiliated hospitals developed the Patients as Partners concept where the patient is considered a full-fledged partner of the health care delivery team and the patient's experiential knowledge is recognized. This study aims to show how patients view their engagement with healthcare professionals regarding their direct care. Using theoretical sampling, 16 semi-structured interviews were conducted with patients with chronic illness who were familiar with the concept of Patients as Partners. Data analysis followed a constructivist grounded theory approach. Patients describe themselves as proactively engaging in three types of practice, regardless of health professionals' openness to their role as partners. The first is a process of continuous learning that allows them to acquire experiential knowledge about their health, as well as scientific information and technical know-how. The second involves their assessment of the healthcare they receive, in terms of its quality and how it aligns with their personal preferences. It includes their assessment of the quality of their relationship with the health professional and of the latter's scientific knowledge and technical know-how. The third type, adaptation practices, builds on patients' learning and assessments to compensate for and adapt to what has been perceived as optimal or non-optimal health or healthcare circumstances. Patients appear to play a more active and less docile role in their own direct care than suggested so far in the literature, regardless of the degree of reciprocity of the partnership or the degree to which the health professional seeks to encourage patient engagement. PMID:25856569
TripAdvisor has changed how the travel industry treats customers. Is the same likely to happen to health services? Review sites are growing fast across Europe, propelled by expansions in patient choice. What impact will they have on the medical profession and on providers, both public and private? How will they change the nature of health care? To address these questions, those at the forefront of developing review sites in Europe were interviewed. PMID:23904237
Lee, Jinhyung; Dowd, Bryan
Objectives This study investigate the effect of health information technology (IT) expenditure on individual patient-level cost using California Office of Statewide Health Planning and Development (OSHPD) data obtained from 2000 to 2007. Methods We used a traditional cost function and applied hospital fixed effect and clustered error within hospitals. Results We found that a quadratic function of IT expenditure best fit the data. The quadratic function in IT expenditure predicts a decrease in...
Thygesen, Marianne K; Fuglsang, Marie; Miiller, Max Mølgaard
completing a questionnaire. A phenomenological-hermeneutical approach was used in the analysis and interpretation. RESULTS: Two major themes emerged: experienced versus expected clinical quality and health-care professional attitude. Patients responded to each question by combining their experiences of both...... play: a care relation and a human relation. This finding can inform health-care practice, but department-specific examples may be needed to initiate improvements. FUNDING: The study received funding from the Centre for Patient Experience and Evaluation, Copenhagen, Denmark. The Danish Scientific...
Johnson-Lawrence, Vicki D.; Szymanski, Benjamin R.; Zivin, Kara; McCarthy, John F.; Valenstein, Marcia; Pfeiffer, Paul N.
Objective: To assess whether Primary Care–Mental Health Integration (PC-MHI) programs within the Veterans Affairs (VA) health system provide services to patient subgroups that may be underrepresented in specialty mental health care, including older patients and women, and to explore whether PC-MHI served individuals with less severe mental health disorders compared to specialty mental health clinics.
Full Text Available The aim of the research was to examine the knowledge levels of the health care personnel working at the first step health institutions about patient rights. It was a descriptive research which was carried out in Melikgazi and Kocasinan Health Group Directorate of Kayseri Province between 1st. of October 2006 and 30th. of May 2007. 406 of 610 health care personnel participated in the study (% 66.5 participation rate. A questionnaire form of 39 questions was utilized. Kruskal-wallis test was used for statistical evaluation. % 56.2 of the health care personnel was 29 years old and younger. % 38.4 of the personnel had undergraduate diploma, % 37.9 was midwife, % 37.2 worked for 10 or 14 years. It was found out that % 42.4 of the personnel was unaware of the patient rights. It was seen in the statistical evaluation that there was a significant statistical difference between the scores of knowledge on patient rights of the personnel and age, educational status, professional group and working period. It was concluded that nearly half of the personnel working at the first step health institutions did not know nothing about patient rights and such variables as age, school from which they graduated, professional status and working period affected knowledge levels of patient rights.
Janette Ellis; Judy Mullan; Anthony Worsley; Nagesh Pai
Background. Patients engage in health information-seeking behaviour to maintain their wellbeing and to manage chronic diseases such as arthritis. Health literacy allows patients to understand available treatments and to critically appraise information they obtain from a wide range of sources. Aims. To explore how arthritis patients' health literacy affects engagement in arthritis-focused health information-seeking behaviour and the selection of sources of health information available through ...
Danielsen, Anne Kjaergaard; Rosenberg, Jacob
included 50 patients in the study. Health related quality of life was measured before hospital discharge, three months and six months after stoma creation. The program included educational interventions involving lay-teachers, alongside health professional teachers. RESULTS: We found a significant rise in...... in health related quality of life baseline (p = 0.045) with lower scores in the intervention group compared with the intervention group. However, there were no significant differences in the demographic variables at baseline. CONCLUSIONS: Educational activities aimed at increase in knowledge and......INTRODUCTION: Adaptation to living with a stoma is complex, and studies have shown that stoma creation has a great impact on patients' health related quality of life. The objective was to explore the effect of a structured patient education program on health related quality of life. Therefore, we...
Mette Lundgaard; Louise Raboel; Elisabeth Broegger Jensen; Jacob Anhoej; Beth Lilja Pedersen; Danish Society for Patient Safety
This paper describes the process that lead to the passing of the Act for Patient Safety in the Danish health care system, the contents of the act and how the act is used in the Danish health care system.
The act obligates frontline health care personnel to report adverse events, hospital owners to act on the reports and the National Board of Health to communicate the learning nationally.
The act protects health care providers from sanctions as a re...
Clemens, Jeffrey; Gottlieb, Joshua D
We investigate whether physicians' financial incentives influence health care supply, technology diffusion, and resulting patient outcomes. In 1997, Medicare consolidated the geographic regions across which it adjusts physician payments, generating area-specific price shocks. Areas with higher payment shocks experience significant increases in health care supply. On average, a 2 percent increase in payment rates leads to a 3 percent increase in care provision. Elective procedures such as cataract surgery respond much more strongly than less discretionary services. Non-radiologists expand their provision of MRIs, suggesting effects on technology adoption. We estimate economically small health impacts, albeit with limited precision. PMID:25170174
Although qualitative research within the field of mental health is growing, few studies of everyday communication between service users and multidisciplinary professionals within mental health institutions exist. This study examines the everyday interactions between mental health professionals and...... by discursive and narrative approaches, the aim of the study is to shed light on how the professionals and users construct patient identities. How are the users and the professionals positioned in their interactions? How are concepts such as psychiatric diagnosis and mental illness negotiated within...
Behrouz Hashemi; Alireza Baratloo; Mohammad Mehdi Forouzafar; Maryam Motamedi; Mohammadreza Tarkhorani
Introduction: After long discussions, carrying out health sector evolution (HSE) plan began on May 5, 2014 throughout Iran. Shohadaye Tajrish Hospital, Tehran, was also included in this plan. This study aimed to evaluate the level of emergency department patient satisfaction, before and after running this plan. Methods: This cross-sectional study analyzed the data extracted from a standard questionnaire filled out by the patients presented to the emergency department of Shohadaye Tajrish Hosp...
Kimerling, Rachel; Pavao, Joanne; Wong, Ava
We utilized a nationally representative survey of women veteran primary care users to examine associations between patient activation and mental health care experiences. A dose–response relationship was observed, with odds of high quality ratings significantly greater at each successive level of patient activation. Higher activation levels were also significantly associated with preference concordant care for gender-related preferences (use of female providers, women-only settings, and women-...
Maha A BahammamDepartment of Periodontology, King Abdulaziz University Faculty of Dentistry, Jeddah, Kingdom of Saudi ArabiaPurpose: This study aimed to examine diabetic patients in Jeddah, Saudi Arabia, regarding their general diabetic and oral health-related awareness and practices, their awareness of the association of diabetes with periodontal disease, and their sources of diabetes-related information.Methods: Diabetic patients (n=454) who were receiving care at the diabete...
Full Text Available LeChauncy D Woodard, Cassie R Landrum, Amber B Amspoker, David Ramsey, Aanand D Naik Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, and Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA Background: Functional health literacy (FHL and patient activation can impact diabetes control through enhanced diabetes self-management. Less is known about the combined effect of these characteristics on diabetes outcomes. Using brief, validated measures, we examined the interaction between FHL and patient activation in predicting glycosylated hemoglobin (HbA1c control among a cohort of multimorbid diabetic patients.Methods: We administered a survey via mail to 387 diabetic patients with coexisting hypertension and ischemic heart disease who received outpatient care at one regional VA medical center between November 2010 and December 2010. We identified patients with the study conditions using the International Classification of Diseases-Ninth Revision-Clinical Modification (ICD-9-CM diagnoses codes and Current Procedure Terminology (CPT procedures codes. Surveys were returned by 195 (50.4% patients. We determined patient activation levels based on participant responses to the 13-item Patient Activation Measure and FHL levels using the single-item screening question, “How confident are you filling out medical forms by yourself?” We reviewed patient medical records to assess glycemic control. We used multiple logistic regression to examine whether activation and FHL were individually or jointly related to HbA1c control.Results: Neither patient activation nor FHL was independently related to glycemic control in the unadjusted main effects model; however, the interaction between the two was significantly associated with glycemic control (odds ratio 1.05 [95% confidence
Cortes, Dharma E.; Mulvaney-Day, Norah; Fortuna, Lisa; Reinfeld, Sarah; Alegria, Margarita
This article highlights results from the Right Question Project-Mental Health (RQP-MH), an intervention designed to teach skills in question formulation and to increase patients' participation in decisions about mental health treatment. Of participants in the RQP-MH intervention, 83% were from a Latino background, and 75% of the interviews were…
Full Text Available Abstract Objectives HIV-infected patients are at increased risk of developing mental health symptoms, which negatively influence the treatment of the HIV-infection. Mental health problems in HIV-infected patients may affect public health. Psychopathology, including depression and substance abuse, can increase hazardous sexual behaviour and, with it, the chance of spreading HIV. Therefore, it is important to develop an optimal treatment plan for HIV-infected patients with mental health problems. The majority of HIV-infected patients in the Netherlands (almost 60% are homosexual men. The main objectives of this study were to describe the clinical and demographic characteristics of patients with HIV who seek treatment for their mental health symptoms in the Netherlands. Secondly, we tested whether HIV infected and non-infected homosexual patients with a lifetime depressive disorder differed on several mental health symptoms. Methods We compared a cohort of 196 patients who visited the outpatient clinic for HIV and Mental Health with HIV-infected patients in the general population in Amsterdam (ATHENA-study and with non-HIV infected mental health patients (NESDA-study. DSM-IV diagnoses were determined, and several self-report questionnaires were used to assess mental health symptoms. Results Depressive disorders were the most commonly occurring diagnoses in the cohort and frequent drug use was common. HIV-infected homosexual men with a depressive disorder showed no difference in depressive symptoms or sleep disturbance, compared with non-infected depressive men. However, HIV-positive patients did express more symptoms like fear, anger and guilt. Although they showed significantly more suicidal ideation, suicide attempts were not more prevalent among HIV-infected patients. Finally, the HIV-infected depressive patients displayed a considerably higher level of drug use than the HIV-negative group. Conclusion Habitual drug use is a risk factor for
Tennvall, Gunnel Ragnarson; Norlin, J M; Malmberg, I;
BACKGROUND: Actinic keratosis (AK) is a common skin condition that may progress to non-melanoma skin cancer (NMSC). The disease may influence Health Related Quality of Life (HRQoL), but studies of HRQoL in patients with AK are limited. The purpose of the study was to analyze HRQoL in patients with......-center setting. Dermatologists assessed AK severity and patients completed: Actinic Keratosis Quality of Life Questionnaire (AKQoL), Dermatology Life Quality Index (DLQI), and EQ-5D-5 L including EQ-VAS. Differences between categorical subgroups were tested with Wilcoxon rank-sum test. The relationship between...
Aziza H. Eldarrat
Full Text Available Objectives : The objectives of the study were to: 1 assess the knowledge and awareness of diabetic patients of their risk for systemic and oral diseases as complications associated with diabetes, 2 to assess their attitudes toward sustaining good oral health through proper oral hygiene and regular dental check-ups, and 3 to the extent that they are aware, to determine how they became aware. Methods : Two hundred self-administered questionnaires were distributed to assess the main objectives of the study. Only completed questionnaires were used in the current study data analysis. Results: A majority of the participants had Type 2 diabetes (58%. The awareness of diabetic patients of their increased risk for oral diseases is low compared to their awareness of systemic diseases. Their attitude toward maintaining good oral health was also not to desired standard. Of the participants, 50% brushed their teeth once daily and 66% never used dental floss. Regarding participants’ sources of awareness, 37% learned from dentists and 45% through other media sources. Conclusions : Diabetic patients are found to have little knowledge of their increased risk for oral diseases. In order to promote proper oral health and to reduce the risk of oral diseases, health professionals in both the dental and medical fields need to take the responsibility to develop programs to educate the public about the oral manifestations of diabetes and its complications on oral health.
Sara Maria Oliveira Pinto
Full Text Available Cancer is a dreaded disease that affects all dimensions of human life. In this context, issues related to the quality of life—as happiness, perception about health status, or health literacy—are important. This study aims to analyze the following topics the perception: the Portuguese cancer patients have about their health status while undergoing chemotherapy, the satisfaction with the information relating to their health, their level of happiness, and their vision of the future. An observational, cross-sectional, and descriptive study was developed. Data were collected between May and July 2012 in the day hospital of a central hospital in northern Portugal. The sample was composed of 92 cancer patients who were asked to answer a questionnaire during chemotherapy. The results indicate that, despite this life-threatening disease, patients consider themselves fairly happy and have an optimistic view of the future. Information about their health condition and religious beliefs was important coping mechanisms to help dealing with the suffering caused by the disease. The study highlights the importance of providing care in a holistic way. Nurses must be alert and available to listen, answer questions, provide supporting structures, or refer to other professionals when needed.
Guise, V; Chambers, M; Välimäki, M
This paper discusses the use of simulation in nursing education and training, including potential benefits and barriers associated with its use. In particular, it addresses the hitherto scant application of diverse simulation devices and dedicated simulation scenarios in psychiatric and mental health nursing. It goes on to describe a low-cost, narrative-based virtual patient simulation technique which has the potential for wide application within health and social care education. An example of the implementation of this technology in a web-based pilot course for acute mental health nurses is given. This particular virtual patient technique is a simulation type ideally suited to promoting essential mental health nursing skills such as critical thinking, communication and decision making. Furthermore, it is argued that it is particularly amenable to e-learning and blended learning environments, as well as being an apt tool where multilingual simulations are required. The continued development, implementation and evaluation of narrative virtual patient simulations across a variety of health and social care programmes would help ascertain their success as an educational tool. PMID:22070549
Sadeghi, Rokhsareh; Taleghani, Ferial; Farhadi, Sareh
Background and aims. Diabetic patients display an increased risk of oral disorders, and oral health related quality of life (OHRQL) might affect their management and treatment modalities. The aim of the present study was to determine OHRQL and associated parameters in patients with diabetes. Materials and methods. In this study two hundred patients were recruited from the diabetes clinic in Mustafa Khomeini Hospital in Tehran, Iran. OHRQL was assessed using Oral Health Impact Profile Questionnaire (OHIP-20). Also, another questionnaire was designed which contained questions regarding participants' knowledge about oral complications of diabetes and oral health behavior. OHRQL was categorized as low and good. Data were analyzed using logistic regression at P = 0.05. Results. Of the diabetic patients assessed, 77.5% were in good and 22.5% were in low categories of OHRQL. This quality was significantly associated with age (OR = 4.03, 95% CI = 1.63-11.29), knowledge about diabetes oral complications (OR = 18.17 95% CI = 4.42-158.6), educational level (OR = 26.31 95% CI = 4.2-1080.3), referred for dental visit by physician (OR = 3.16 95% CI = 1.48-6.69), frequency of brushing (OR = 10.29 95% CI = 3.96-31.2) and length of time diagnosed with diabetes (OR = 6.21 95% CI = 2.86-13.63). Conclusion. Oral health related quality of life was not negatively affected by diabetes mellitus in the assessed sample. PMID:25587385
Haruty, Bella; Friedman, Julie; Hopp, Stephanie; Daniels, Ryane; Pregler, Janet
Endocrine-disrupting chemicals (EDCs) are associated with reproductive complications such as infertility, pregnancy complications, poor birth outcomes, and child developmental abnormalities, although not all chemicals of concern are EDCs. Pregnant patients and women of childbearing age need reasonable advice about environmental contaminants and reproductive health. PMID:27168513
Habibović, Mirela; Versteeg, Henneke; Pelle, Aline J M;
Implantable cardioverter defibrillator (ICD) therapy, which includes the risk of shocks, is considered the primary culprit of reductions in patient reported outcomes (PROs; e.g. health status and distress), thereby negating the role of underlying disease severity. We examined the relative influen...
Wood, William A; Bennett, Antonia V; Basch, Ethan
Recent advancements in consumer directed personal computing technology have led to the generation of biomedically-relevant data streams with potential health applications. This has catalyzed international interest in Patient Generated Health Data (PGHD), defined as "health-related data - including health history, symptoms, biometric data, treatment history, lifestyle choices, and other information-created, recorded, gathered, or inferred by or from patients or their designees (i.e. care partners or those who assist them) to help address a health concern."(Shapiro et al., 2012) PGHD offers several opportunities to improve the efficiency and output of clinical trials, particularly within oncology. These range from using PGHD to understand mechanisms of action of therapeutic strategies, to understanding and predicting treatment-related toxicity, to designing interventions to improve adherence and clinical outcomes. To facilitate the optimal use of PGHD, methodological research around considerations related to feasibility, validation, measure selection, and modeling of PGHD streams is needed. With successful integration, PGHD can catalyze the application of "big data" to cancer clinical research, creating both "n of 1" and population-level observations, and generating new insights into the nature of health and disease. PMID:25248998
Full Text Available Abstract Background To assess factors associated with visits to GPs, orthopaedists, and non-physician practitioners of complementary medicine (alternative practitioners by primary care patients with osteoarthritis (OA. Methods Cross-sectional survey among 1250 consecutively addressed patients from 75 primary care practices in Germany. All patients suffered from OA of the knee or hip according to ACR criteria. They received questionnaires collecting sociodemographic data, data about health service utilisation, prescriptions, comorbidities. They also included established instruments as the Arthritis Impact Measurement Scale (AIMS2-SF to assess disease-specific quality of life and the Patient Health Questionnaire (PHQ-9 to assess depression. Hierarchical stepwise multiple linear regression models were used to reveal significant factors influencing health service utilization. Results 1021 of 1250 (81.6% questionnaires were returned. Nonrespondents did not differ from participants. Factors associated with health service use (HSU varied between providers of care. Not being in a partnership, achieving a high score on the PHQ-9, increased pain severity reflected in the “symptom” scale of the AIMS2-SF, and an increased number of drug prescriptions predicted a high frequency of GP visits. The PHQ-9 score was also a predictor for visits to orthopaedists, as were previous GP contacts, a high score in the "symptom" scale as well as a high score in the "lower limb scale" of the AIMS2-SF. Regarding visits to alternative practitioners, a high score in the AIMS -"social" scale was a positive predictor as older people were less likely to visit them. Conclusion Our results emphasize the need for awareness of psychological factors contributing to the use of health care providers. Addressing the revealed factors associated with HSU appropriately may lead to decreased health care utilization. But further research is needed to assess how this can be done
Many breast cancer patients use complementary and alternative medicine (CAM). We aimed to determine what advice health food store employees present to individuals seeking treatment options for breast cancer. Eight data gatherers asked employees of all retail health food stores in a major Canadian city, what they recommended for a patient with breast cancer. The data gatherers inquired about product safety, potential drug interactions, costs and efficacy. They also enquired about employee training related to the products. Thirty-four stores were examined. A total of 33 different products were recommended, none of which are supported by sufficient evidence of efficacy. The average cost of the products they recommended was $58.09 (CAD) (minimum $5.28, median $32.99, maximum $600) per month. Twenty-three employees (68%) did not ask whether the patient took prescription medications. Fifteen employees (44%) recommended visiting a healthcare professional (naturopaths (9), physicians (5), nutritionists (1). Three employees (8.8%) discussed potential adverse effects of the products. Eight employees (23.5%) discussed the potential for drug interactions. Two employees (5.9%) suggested a possible cure with the products and one employee (2.9%) suggested discontinuing Tamoxifen. Four employees (11.8%) recommended lifestyle changes and three employees (8.8%) recommended books for further reading on the products. This study draws attention to the heterogeneity of advice provided by natural health food stores to individuals seeking treatments for breast cancer, and the safety and cost implications of some of the products recommended. Physicians should enquire carefully about the use of natural health food products by patients with breast cancer. Regulators need to consider regulations to protect vulnerable patients from incurring significant costs in their purchasing of natural health food products lacking evidence of benefit and of questionable safety
Carolinas HealthCare System has grown into a nearly two billion dollar entity by focusing on patient needs and amenities in its health care facilities. Growth of the system, the largest in North and South Carolina, is due in large part to Harry A. Nurkin, president and CEO, who started out with a run-down hospital for indigents. With the approval of the hospital board, Nurkin launched a marketing effort that included taking a lesson from the founders of the Holiday Inn hotel chain. He remodeled and developed facilities that are pleasing to patients and visitors, moved patient parking closer to the hospitals' front doors, taught key hospital personnel the basics about marketing, aligned the system with ABA and NFL teams and conducted an aggressive advertising program. PMID:11143133
Munoz, E; Chalfin, D; Goldstein, J; Lackner, R; Mulloy, K; Wise, L
Prospective hospital payment systems using the federal Medicare DRG payment model are changing hospital reimbursement. Currently, many states have adopted diagnosis related group (DRG) prospective "all payer systems" using the federal model. All payer systems, whereby Medicaid, Blue Cross, and other commercial insurers pay by the DRG mode, prevent cost shifting between payers. New York state has used an all payer system since Jan 1, 1988. This study simulated DRG all payer methods for a large sample (N = 16,084) of pediatric patients for a three-year period using the New York DRG all payer reimbursement system now in effect. Medicaid pediatric patients had (adjusted for DRG weight index) a longer hospital stay and greater total hospital cost compared with pediatric patients from Blue Cross and other commercial payers. Medicaid pediatric patients also had a greater severity of illness compared with patients from Blue Cross and other payers. Pediatric patients in all payment groups (ie, Medicaid, Blue Cross, and other commercial insurers) generated financial risk under the DRG all payer scheme. Medicaid pediatric patients generated the greatest financial risk, however. These data suggest that state and private payers may be under-reimbursing for the care of the hospitalized pediatric patient using the DRG prospective hospital payment scheme. Health care financing policy for pediatric patients may limit both access and quality of care. PMID:2492754
Schnee, M; Grikscheit, F
Health locus of control beliefs plays a major role in improving self-management skills of the chronically ill - a main goal in disease management programmes (DMP). This study aims at characterising participants in disease management regarding their health locus of control. Data are based on 4 cross-sectional postal surveys between spring and autumn of 2006 and 2007 within the Health Care Monitor of the Bertelsmann Foundation. Among the 6 285 respondents, 1 266 are chronically ill and not enrolled in a DMP and 327 are participating in a DMP. A high internal locus of control (HLC) occurs significantly less often in DMP patients than in normal chronically ill patients (and healthy people) controlling for age, gender and social class. With increasing age, a high internal locus of control is also significantly less likely. When comparing healthy people, the chronically ill and the DMP participants a social gradient of a high internal locus of control belief can be observed. The weaker internal and higher doctor-related external locus of control of DMP participants should be carefully observed by the physician when trying to strengthen the patients' self-management skills. Evaluators of DMP should take into account the different baselines of DMP patients and relevant control groups and incorporate these differences into the evaluation. PMID:22864845
Muñoz, E; Barrau, L; Goldstein, J; Benacquista, T; Mulloy, K; Wise, L
The Medicare diagnosis-related group (DRG) prospective payment system is now entering its 6th year, with no reported major adverse effects on the health status of the American people. Currently 13 states are using DRG prospective "all-payer systems" for hospital reimbursement; other state may adopt DRG all payer systems. In DRG all-payer systems, Medicare, Medicaid, Blue Cross, and other commercial insurers pay by the DRG mode; New York state has been all-payer since January 1, 1988. This study simulated DRG all-payer methods on a large sample (n = 558) of adult nephrology patients for a 2-year period using both federal and New York DRG reimbursements now in effect. Both Medicare and Medicaid patients had (on average) longer hospital lengths of stay and higher total hospital costs compared with patients from Blue Cross and other commercial payers. Medicare and Medicaid patients also had greater severity of illness than patients from Blue Cross or other payers. However, all payers (ie, Medicaid, Blue Cross, Medicare, and commercial insurers) generated significant financial risk under our DRG all-payer scheme. These data suggest that federal, state, and private payers may be underreimbursing for the care of hospitalized nephrology patients using the DRG prospective hospital payment scheme. As DRG payment rates are further reduced compared with the real hospital costs of treating patients, both the access to and the quality of care for many nephrology patients may be jeopardized. PMID:3143261
Ezenwaka, C E; Offiah, N V
We previously reported poor metabolic control in type 2 diabetic patients attending 2 primary care clinics in Trinidad. In an attempt to explain the poor metabolic control, we assessed primary care patients' theoretical knowledge of diabetes control and risk factors. Two hundred fifty-four diabetic out-patients recruited consecutively were asked by questionnaire: (i) if they were aware that family history of diabetes, obesity, physical inactivity and cigarette smoking were diabetes risk factors; (ii) if they knew the benefits of weight loss, exercise and healthy diet in diabetes management, and (iii) what where their common sources of diabetes health information. Although the majority of the patients (81.1%) were unaware that cigarette smoking is a diabetes risk factor, a majority were aware that obesity (66.3%), physical inactivity (73.5%) and being a relative of a diabetic patient (78.7%) constitute diabetes risk factors. Again, the majority of the patients were aware that healthy diet (94.9%), exercise (94.5%) and weight loss (87.4%) are beneficial in diabetes control. While media (48.6%) was the commonest source of diabetes information, doctors and nurses were consulted by 39.9% and 11.0% of patients, respectively. Type 2 diabetic patients in these clinics were well informed about diabetes risk factors and benefits of healthy lifestyle. Given our recent reports on poor metabolic control, application of this theoretical knowledge in controlling their diabetes remains doubtful. PMID:14740276
Davies, E; Yeoh, K-W
Background: Reliable information can improve patients' knowledge of chemotherapy. As internet chemotherapy information (ICI) is increasingly viewed as a valuable patient education tool, we investigated the impact of ICI on patient care and analysed health professionals' (HPs') attitudes towards ICI. Methods: The following questionnaires were distributed: (1) self-administered questionnaire randomly given to 261 patients receiving chemotherapy (80% returned); and (2) separate questionnaire given to 58 HPs at the same UK Oncology Centre (83% returned). Results: Just over half of the patient respondents accessed the internet regularly. They were younger, with higher incomes and qualifications. Key search topics included chemotherapy modes of action, symptom management and treatment success, and most considered ICI useful. More than half wanted to discuss ICI with HPs but most did not get the opportunity. Although the majority of HP respondents supported the need for patients to retrieve ICI, most questioned the accuracy of ICI and did not routinely recommend its use. Conclusion: This study has shown that ICI is generally perceived by patients to be a valuable information resource. Given the potential impact of ICI, the following should be addressed in future studies: (1) inequalities in accessing ICI; (2) maintaining the quality of ICI (with clear guidance on recommended websites); (3) bridging the gap between the perception of ICI by patients and HPs; (4) integration of ICI with traditional consultation models. PMID:22262319
Jaarsma, T.; Larsen, Torben; Stromberg, A.
following components: integrated multidisciplinary care, patient and partner participation, care plans with clear goals of care, patient education, self-care management, appropriate access to care and optimised treatment. Discussion: We summarised the state of the art of home-based care for heart failure......Introduction: Chronic heart failure is a common condition affecting up to 15 million people in the extended Europe. Heart failure is burdensome and costly for patients in terms of decreased quality of life and poor prognosis, and it is also costly for society. Better integrated care is warranted in...... this population and specialised heart failure care can save costs and improve the quality of care. However, only a few European countries have implemented specialised home care and offered this to a larger number of patients with heart failure. Method: We developed a guide on Home Health in Heart...
Full Text Available Introduction. People with psychiatric disorders are at high risk of oral diseases due to the impact of their primary psychiatric condition and the side-effects of antipsychotic medications. Objective. The aim of this study was to identify habits, attitudes and behavior towards oral health of hospitalized psychiatric patients with psychotic disorders, including mood disorders with psychotic characteristics, as well as to identify factors that could influence those habits, attitudes and behavior. Methods. The experimental group consisted of 186 hospitalized patients with psychiatric disorders (87 males and 99 females, aged from 18 to 59 years (mean age 46.0±8.0 years. The control group consisted of 186 healthy persons matched for age and gender. Data were obtained by using specially designed questionnaires with questions about the subjects' social, economic and demographic characteristics, as well as their habits, attitudes and behaviour concerning their oral health, in a form of a standardized interview. Other medical data were collected from medical documentation of disease history. Statistical analysis was performed by Student's t-test, Chi-square test, ANOVA, Logistic Regression and simultaneous multiple regression. Results. Psychiatric patients have worse habits, attitudes and behavior concerning their oral health in comparison with healthy persons (p<0.001: they wash their teeth more rarely and in a shorter time, have less knowledge of oral diseases and their effect on general health, and visit their dentist more rarely. The obtained results depend on social, economic and demographic characteristics and on the underlying illness of patients. Conclusion. Health educational work concerning oral health of patients should be included in psychiatric treatment, as a part of an existing therapy with the aim of improving the general quality of their life.
Muñoz, E; Barrau, L; Goldstein, J; Benacquista, T; Mulloy, K; Wise, L
Several federal bodies provide ongoing analyses of the Medicare DRG prospective hospital payment system. Many states are using DRG prospective "all payor systems" for hospital reimbursement (based on the federal model). In All Payor Systems, Medicare, Medicaid, Blue Cross and other commercial insurers pay by the DRG mode; New York State has been All Payor since 1/1/88. This study simulated DRG All Payor methods on a large sample (n = 1,662) of pulmonary medicine patients for a two-year period using both federal and New York DRG reimbursement now in effect at our hospital. Medicare patients had (on average) a longer hospital length of stay and total hospital cost compared to patients from Medicaid, Blue Cross, and other commercial payors. Medicare patients also had a greater severity of illness compared to patients from Blue Cross Medicaid or other payors. All payors, however, (Medicaid, Blue Cross, Medicare and commercial insurers) generated significant financial risk under the DRG All Payor scheme. These data suggest that federal, state, and private payors may be underreimbursing for the care of the hospitalized pulmonary medicine patients using the DRG prospective hospital payment scheme. Health care financing policy, as demonstrated in this study, may limit both the access and quality of care for many pulmonary medicine patients in the future. PMID:2491799
Muñoz, E; Zahtz, G; Goldstein, J; Benacquista, T; Mulloy, K; Wise, L
The Medicare diagnosis related group (DRG) prospective payment model is changing hospital payment. Currently many states are using DRG prospective "All Payor Systems" for hospital reimbursement. In All Payor Systems, Medicare, Medicaid, Blue Cross, and other commercial insurers pay by the DRG mode; New York State has been All Payor since Jan 1, 1988. This study simulated DRG All Payor methods on a large sample (N = 1074) of adult otolaryngology patients for a two-year period using both federal and New York DRG reimbursement now in effect. Both Medicare and Medicaid patients had (on average) a longer hospital stay and total hospital cost compared with patients from Blue Cross and other commercial payors. Medicare and Medicaid patients also had a greater severity of illness compared with patients from Blue Cross or other payors. All payors (ie, Medicaid, Blue Cross, and commercial insurers), except Medicare, generated financial risk under the DRG All Payor scheme. These data suggest that state and private payors may be underreimbursing for the care of the hospitalized otolaryngology patient using the DRG prospective hospital payment scheme. Health care financing policy described in this study may limit both the access and/or the quality of care for many otolaryngology patients in the future. PMID:3139014
Vozza, Iole; Cavallè, Edoardo; Corridore, Denise; Ripari, Francesca; Spota, Andrea; Brugnoletti, Orlando; Guerra, Fabrizio
As regards to the most common oral disease in pediatric patients, intellectual disability is not a risk factor for caries disease itself, but it rather reduces the individual capability to self-care and therefore to his own oral care. Children suffering of systemic pathologies and/or with different stages of disability are to be considered at high risk for dental caries development. According to recent guidelines for oral health prevention in childhood, individual additional strategies for a ...
Background Deployment of electronic patient records (EPRs) is one of the primary goals of national NHS information technology (IT) initiatives. However, many systems come into disrepute through poor planning or design flaws, and media scrutiny focuses on these problems rather than the potential gains. Objective To evaluate the deployment of an EPR in a community mental health setting. Method A validated user questionnaire was issued to all clinically qualified staff working in community...
Gencer, Baris; Rodondi, Nicolas; Auer, Reto; Nanchen, David; Räber, Lorenz; Klingenberg, Roland; Pletscher, Mark; Jüni, Peter; Windecker, Stephan; Matter, Christian M; Lüscher, Thomas F; Mach, François; Perneger, Thomas V; Girardin, François R
Background Acute coronary syndromes (ACS) have been associated with lower health utilities (HUs) compared with the general population. Given the prognostic improvements after ACS with the implementation of coronary angiography (eg, percutaneous coronary intervention (PCI)), contemporary HU values derived from patient-reported outcomes are needed. Methods We analysed data of 1882 patients with ACS 1 year after coronary angiography in a Swiss prospective cohort. We used the EuroQol five-dimensional questionnaire (EQ-5D) and visual analogue scale (VAS) to derive HU indexes. We estimated the effects of clinical factors on HU using a linear regression model and compared the observed HU with the average values of individuals of the same sex and age in the general population. Results Mean EQ-5D HU 1-year after coronary angiography for ACS was 0.82 (±0.16) and mean VAS was 0.77 (±0.18); 40.9% of participants exhibited the highest utility values. Compared with population controls, the mean EQ-5D HU was similar (expected mean 0.82, p=0.58) in patients with ACS, but the mean VAS was slightly lower (expected mean 0.79, p<0.001). Patients with ACS who are younger than 60 years had lower HU than the general population (<0.001). In patients with ACS, significant differences were found according to the gender, education and employment status, diabetes, obesity, heart failure, recurrent ischaemic or incident bleeding event and participation in cardiac rehabilitation (p<0.01). Conclusions At 1 year, patients with ACS with coronary angiography had HU indexes similar to a control population. Subgroup analyses based on patients' characteristics and further disease-specific instruments could provide better sensitivity for detecting smaller variations in health-related quality of life. PMID:27252878
Full Text Available BACKGROUND: Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs. Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. METHODS: The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. RESULTS: In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. CONCLUSIONS: Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so
Full Text Available Maha A BahammamDepartment of Periodontology, King Abdulaziz University Faculty of Dentistry, Jeddah, Kingdom of Saudi ArabiaPurpose: This study aimed to examine diabetic patients in Jeddah, Saudi Arabia, regarding their general diabetic and oral health-related awareness and practices, their awareness of the association of diabetes with periodontal disease, and their sources of diabetes-related information.Methods: Diabetic patients (n=454 who were receiving care at the diabetes clinic in King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from October 2013 to May 2014, completed a six-part questionnaire assessing their sociodemographic characteristics, general and oral health awareness and practices, and sources of diabetes-related information. Descriptive statistics were used to report the results.Results: The responses indicated inadequate health-related practices in the surveyed group: 22.2% brushed their teeth twice daily, 73.6% never flossed their teeth, and while 80.2% visited a physician in the past year, only 12.6% visited a dentist during the same year. Of the respondents, 94.8% reported that they had never received advice on oral hygiene tasks in relation to diabetes from a health professional. Awareness about the diabetes and periodontal disease association was limited: 46.7% knew that diabetics have gum problems more often if their blood sugar stays very high, and only 21.8% knew that gum disease makes it harder to control blood sugar in diabetic patients. A significant association (P<0.05 was found between a higher level of education and greater general and oral awareness, as well as a significant association (P<0.05 between longer duration of disease, regular exercise, and regular visits to the physician and awareness about diabetes mellitus. Additionally, a significant association (P<0.05 was found between regular dental visits and both periodontal disease and diabetes awareness. Family and friends were the main source of
Singhania, P R; Mandalika, S
The recent emphasis on assessment of the psychological status, availability of newer and better methods of interpreting the anthropometric measurements of renal patients on dialysis therapy prompted the authors to develop the "Holistic Health Assessment Tool for dialysis patients (HHAT-D)." A total of 30 subjects (25-65 years), enrolled from dialysis centers in Mumbai were administered the HHAT-D tool to assess anthropometric, biochemical, functional, and psychological status (knowledge, needs, that coping strategies) along with dietary intake. The results showed that majority of the patients (73.3%) were mild to moderately malnourished. A highly significant negative correlation of anthropometric measurements (BMI, lean body mass, mid arm circumference, arm muscle area, bicep skin fold thickness, % usual body weight, and % standard body weight) with the HHAT-D scores (P23162270
Muñoz, E; Johnson, H; Goldstein, J; Benacquista, T; Mulloy, K; Wise, L
The Medicare diagnostic-related group (DRG) prospective payment model is changing hospital payment. Currently many states are using DRG prospective "all payer systems" for hospital reimbursement. In all payer systems, Medicare, Medicaid, Blue Cross, and other commercial insurers pay by the DRG mode; New York State has had an all payer system since January 1, 1988. This study simulated DRG all payer methods on a large sample (N = 6,134) of adult black medical and surgical patients for a three-year period using both federal and New York DRG reimbursement. Both Medicare and Medicaid patients had, on average, a longer hospital stay and total hospital cost compared with patients covered by Blue Cross and other commercial insurers. Medicare and Medicaid patients also had a greater severity of illness compared with those of Blue Cross and others. All insurers (ie, Medicaid, Blue Cross, Medicare, and commercial) generated substantial financial risk under the DRG all payer scheme. These data suggest that federal, state, and private payers may be under-reimbursing for the care of the hospitalized black patient using the DRG prospective hospital payment scheme. Health care financing policy such as that demonstrated in this study may limit both the access and quality of care for many black patients in the future. PMID:3149307
Scales, Charles D; Tasian, Gregory E; Schwaderer, Andrew L; Goldfarb, David S; Star, Robert A; Kirkali, Ziya
Expanding epidemiologic and physiologic data suggest that urinary stone disease is best conceptualized as a chronic metabolic condition punctuated by symptomatic, preventable stone events. These acute events herald substantial future chronic morbidity, including decreased bone mineral density, cardiovascular disease, and CKD. Urinary stone disease imposes a large and growing public health burden. In the United States, 1 in 11 individuals will experience a urinary stone in their lifetime. Given this high incidence and prevalence, urinary stone disease is one of the most expensive urologic conditions, with health care charges exceeding $10 billion annually. Patient care focuses on management of symptomatic stones rather than prevention; after three decades of innovation, procedural interventions are almost exclusively minimally invasive or noninvasive, and mortality is rare. Despite these advances, the prevalence of stone disease has nearly doubled over the past 15 years, likely secondary to dietary and health trends. The NIDDK recently convened a symposium to assess knowledge and treatment gaps to inform future urinary stone disease research. Reducing the public health burden of urinary stone disease will require key advances in understanding environmental, genetic, and other individual disease determinants; improving secondary prevention; and optimal population health strategies in an increasingly cost-conscious care environment. PMID:26964844
Fleurence, Rachael L; Beal, Anne C; Sheridan, Susan E; Johnson, Lorraine B; Selby, Joe V
The era of big data, loosely defined as the development and analysis of large or complex data sets, brings new opportunities to empower patients and their families to generate, collect, and use their health information for both clinical and research purposes. In 2013 the Patient-Centered Outcomes Research Institute launched a large national research network, PCORnet, that includes both clinical and patient-powered research networks. This article describes these networks, their potential uses, and the challenges they face. The networks are engaging patients, family members, and caregivers in four key ways: contributing data securely, with privacy protected; including diverse and representative groups of patients in research; prioritizing research questions, participating in research, and disseminating results; and participating in the leadership and governance of patient-powered research networks. If technical, regulatory, and organizational challenges can be overcome, PCORnet will allow research to be conducted more efficiently and cost-effectively and results to be disseminated quickly back to patients, clinicians, and delivery systems to improve patient health. PMID:25006148
Ramirez, Veronica; Johnson, Emily; Gonzalez, Cesar; Ramirez, Vanessa; Rubino, Barbara; Rossetti, Gina
Background There is significant potential for mobile health technology to improve health outcomes for patients with chronic diseases. However, there is a need for further development of mobile health technology that would help to improve the health of lower-income communities. Objective The study objective was to assess mobile phone and app usage among a culturally diverse patient population, and to determine whether patients would be interested in using mobile health technology to help manag...
Podlekareva, D N; Grint, D; Post, F A;
To assess health care utilisation for patients co-infected with TB and HIV (TB-HIV), and to develop a weighted health care index (HCI) score based on commonly used interventions and compare it with patient outcome.......To assess health care utilisation for patients co-infected with TB and HIV (TB-HIV), and to develop a weighted health care index (HCI) score based on commonly used interventions and compare it with patient outcome....
Alsenany, Samira; Al Saif, Amer
[Purpose] This study analyzed type 2 diabetes and its role in complications among adult Saudi patients. [Subjects] Patients attending four primary health care centers in Jeddah were enrolled. [Methods] A cross-sectional design study among Saudi patients attending Ministry of Health primary health care centers in Jeddah was selected for use by the Primary Health Care administration. Patients were interviewed with structured questionnaires to determine the presence of diabetes and risk factors ...
Hanson, Carl L; West, Josh; Thackeray, Rosemary; Barnes, Michael D; Downey, Jordan
Background The use of social media by health care organizations is growing and provides Web-based tools to connect patients, caregivers, and providers. Objective The aim was to determine the use and factors predicting the use of social media for health care–related purposes among medically underserved primary care patients. Methods A cross-sectional survey was administered to 444 patients of a federally qualified community health center. Results Community health center patients preferred that...
Helle Ploug. Hansen; Eva Draborg; Finn Brlum. Kristensen
Health systems are placing more and more emphasis on the design and delivery of services that are focused on the patient, and there is a growing interest in patient involvement in health policy research and health technology assessment (HTA). Furthermore, there is a growing research interest in eliciting patients' views, not only on 'what works' for patients but also on the need for intervention and on factors influencing the implementation of particular health technologies, their appropriate...
Miotto, Riccardo; Li, Li; Kidd, Brian A; Dudley, Joel T
Secondary use of electronic health records (EHRs) promises to advance clinical research and better inform clinical decision making. Challenges in summarizing and representing patient data prevent widespread practice of predictive modeling using EHRs. Here we present a novel unsupervised deep feature learning method to derive a general-purpose patient representation from EHR data that facilitates clinical predictive modeling. In particular, a three-layer stack of denoising autoencoders was used to capture hierarchical regularities and dependencies in the aggregated EHRs of about 700,000 patients from the Mount Sinai data warehouse. The result is a representation we name "deep patient". We evaluated this representation as broadly predictive of health states by assessing the probability of patients to develop various diseases. We performed evaluation using 76,214 test patients comprising 78 diseases from diverse clinical domains and temporal windows. Our results significantly outperformed those achieved using representations based on raw EHR data and alternative feature learning strategies. Prediction performance for severe diabetes, schizophrenia, and various cancers were among the top performing. These findings indicate that deep learning applied to EHRs can derive patient representations that offer improved clinical predictions, and could provide a machine learning framework for augmenting clinical decision systems. PMID:27185194
Full Text Available Introduction: After long discussions, carrying out health sector evolution (HSE plan began on May 5, 2014 throughout Iran. Shohadaye Tajrish Hospital, Tehran, was also included in this plan. This study aimed to evaluate the level of emergency department patient satisfaction, before and after running this plan. Methods: This cross-sectional study analyzed the data extracted from a standard questionnaire filled out by the patients presented to the emergency department of Shohadaye Tajrish Hospital over 6-month periods before and after the beginning of HSE. Results: 3665 patients were surveyed. After the execution of the plan, satisfaction decreased significantly regarding pre-discharge training (p = 0.03, hospitalization room condition (p = 0.0002, restroom sanitation (p = 0.007, waiting time to be visited by the physician (p = 0.04, accuracy and duration of physical examination (p = 0.007, feeling confident and desirable outcome (p = 0.03, commitment to religious and moral principles (p = 0.01, and handling financial affairs (p = 0.03. Conclusion: Based on the results of the present study, after execution of HSE plan, patient satisfaction has decreased significantly regarding pre-discharge training, hospitalization room condition, restroom sanitation, timely visit of the physicians, accuracy and duration of physical examination, suggestions for wellbeing of the patient, handling financial affairs, and commitment to religious and moral principles.
Background: The ability to measure health and the value of improving or declining health is crucial to the evaluation of health care interventions. Many generic and disease specific health status measures exist for use in patients with rheumatoid arthritis (RA). The Overall Status in Rheumatoid Arthritis (OSRA) measure is a new and simple measure with early evidence of construct validity. Generic health profiles with attached utility weights such as the EuroQol EQ-5D and the SF-6D (calculated...
Ückert, F.; Müller, ML; Bürkle, T; Prokosch, HU
The department of Medical Informatics of the University Hospital Münster and the Gesakon GmbH (an university offspring) initiated the cooperative development of an electronic health record (EHR) called "akteonline.de" in 2000. From 2001 onwards several clinics of the university hospital have already offered this EHR (within pilot projects) as an additional service to selected subsets of their patients. Based on the experiences of those pilot projects the system architecture and the basic data...
Becker, Rachel W.; McCrillis, Aileen
Objective: The purpose of this study was to determine the prevalence of secondary traumatic stress (STS) in health sciences librarians (HSLs) who have direct contact with traumatized individuals and their families. Methods: A twenty-five-item survey and the Secondary Traumatic Stress Scale (STSS) were distributed via email to three Medical Library Association email discussion lists. Results: A total of fifty-five HSLs responded to the survey. Survey results indicate moderate levels of STS and variability of symptoms among participants. Conclusions: Library and employee assistance program managers should be aware of the emotional toll of patient and/or family contact for HSLs. PMID:25918488
Miotto, Riccardo; Li, Li; Kidd, Brian A.; Dudley, Joel T.
Secondary use of electronic health records (EHRs) promises to advance clinical research and better inform clinical decision making. Challenges in summarizing and representing patient data prevent widespread practice of predictive modeling using EHRs. Here we present a novel unsupervised deep feature learning method to derive a general-purpose patient representation from EHR data that facilitates clinical predictive modeling. In particular, a three-layer stack of denoising autoencoders was used to capture hierarchical regularities and dependencies in the aggregated EHRs of about 700,000 patients from the Mount Sinai data warehouse. The result is a representation we name “deep patient”. We evaluated this representation as broadly predictive of health states by assessing the probability of patients to develop various diseases. We performed evaluation using 76,214 test patients comprising 78 diseases from diverse clinical domains and temporal windows. Our results significantly outperformed those achieved using representations based on raw EHR data and alternative feature learning strategies. Prediction performance for severe diabetes, schizophrenia, and various cancers were among the top performing. These findings indicate that deep learning applied to EHRs can derive patient representations that offer improved clinical predictions, and could provide a machine learning framework for augmenting clinical decision systems. PMID:27185194
Pedersen, Susanne S.; Versteeg, Henneke; Denollet, Johan;
In patients treated with percutaneous coronary intervention (PCI) with the paclitaxel-eluting stent, we examined whether patient-rated health status predicts adverse clinical events.......In patients treated with percutaneous coronary intervention (PCI) with the paclitaxel-eluting stent, we examined whether patient-rated health status predicts adverse clinical events....
Brouwers, Corline; Caliskan, Kadir; Bos, Sven;
patients and 42 DCM patients. Outcome measures were health status (Short Form Health Survey-12), anxiety (Generalized Anxiety Disorder 7-item scale) and depression (Patient Health Questionnaire 9-item scale). RESULTS: NCCM patients showed significantly worse health status (Physical Component Score F(1...... levels of anxiety and depressive symptoms in NCCM, whereas the burden of having a genetic condition may contribute less to these health status and psychological measures.......BACKGROUND: Non-compaction cardiomyopathy (NCCM) is a cardiomyopathy characterized by left ventricular tribeculae and deep intertrabecular recesses. Because of its genetic underpinnings and physical disease burden, noncompaction cardiomyopathy is expected to be associated with a lower health status...
Bard, Jonathan F; Shu, Zhichao; Morrice, Douglas J; Wang, Dongyang Ester; Poursani, Ramin; Leykum, Luci
This paper presents an analysis of a residency primary care clinic whose majority of patients are underserved. The clinic is operated by the health system for Bexar County and staffed primarily with physicians in a three-year Family Medicine residency program at The University of Texas School of Medicine in San Antonio. The objective of the study was to obtain a better understanding of patient flow through the clinic and to investigate changes to current scheduling rules and operating procedures. Discrete event simulation was used to establish a baseline and to evaluate a variety of scenarios associated with appointment scheduling and managing early and late arrivals. The first steps in developing the model were to map the administrative and diagnostic processes and to collect time-stamped data and fit probability distributions to each. In conjunction with the initialization and validation steps, various regressions were performed to determine if any relationships existed between individual providers and patient types, length of stay, and the difference between discharge time and appointment time. The latter two statistics along with resource utilization and closing time were the primary metrics used to evaluate system performance.The results showed that up to an 8.5 % reduction in patient length of stay is achievable without noticeably affecting the other metrics by carefully adjusting appointment times. Reducing the no-show rate from its current value of 21.8 % or overbooking, however, is likely to overwhelm the system's resources and lead to excessive congestion and overtime. Another major finding was that the providers are the limiting factor in improving patient flow. With an average utilization rate above 90 % there is little prospect in shortening the total patient time in the clinic without reducing the providers' average assessment time. Finally, several suggestions are offered to ensure fairness when dealing with out-of-order arrivals. PMID:25155098
Steegers-Theunissen, Régine P M; Steegers, Eric A P
The worldwide epidemic of non-communicable diseases (NCD), including obesity, is a burden to which poor lifestyles contribute significantly. Events in early life may enhance susceptibility to NCD, with transmission into succeeding generations. This may also explain, in part, why interventions in adulthood are less effective to reduce NCD risk. New insights reveal that the early embryo, in particular, is extremely sensitive to signals from gametes, trophoblastic tissue and periconception maternal lifestyles. Embryonic size and growth as determinants of embryonic health seem to impact future health. A relatively small embryo for gestational age is associated with pregnancy complications, as well as with the risk of early features of NCD in childhood. Although personal lifestyles are modifiable, they are extremely difficult to change. Therefore, adopting a life course approach from the periconception period onwards and integrated into patient care with short-term reproductive health benefits may have important implications for future prevention of NCD. The current reproductive population is used to Internet and social media. Therefore, they can be reached via mobile phone (mHealth) platforms that provide personalised lifestyle (pre)pregnancy programs. This will offer opportunities and possibly great benefits for the health of current and succeeding generations. PMID:25771352
Plotnikova, Evgeniya Vadimovna
Cross-border labour mobility in the health sector is portrayed as both an opportunity for health professionals immigrating to developed countries, and as a challenge for patients remaining in low-income countries with restricted access to health care provision. In policy debate, this problem is articulated as the opposition between, 'the right to freedom of movement' and 'the right to health'. The underlying layers of this dilemma expose competing institutional interests for source and destination countries, international organisations, private recruitment agencies, trade unions and professional organisations. To resolve some of these tensions, a 'soft law' regulation (ethical recruitment policy) was adopted in the UK in the early 2000s. This article argues that this ethical recruitment policy produces an ambivalent effect. The qualitative content analysis refers to documents produced by international organisations, government bodies, professional organisations and trade unions in the UK and source countries. We found that ethical recruitment on the one hand proposes a practical mechanism to the realisation of the right to health in source countries, through encouraging employers' behaviour in accordance with ethical principles in international recruitment. On the other hand, this policy protects the reputation of institutional stakeholders changing rhetoric around international recruitment rather than the practice. The findings of this study contribute to a broader discussion of the international norms diffusion and the ambivalent role of 'soft law' in their implementation. PMID:21435766
Kalckreuth, Sophie; Trefflich, Friederike; Rummel-Kluge, Christine
Background The Internet is of great importance in today’s health sector, as most Internet users utilize online functions for health related purposes. Concerning the mental health care sector, little data exist about the Internet use of psychiatric patients. It is the scope of this current study to analyze the quantity and pattern of Internet usage among mental health patients. Methods Patients from all services of the Department of Psychiatry at a university hospital were surveyed by completi...
Mojtaba Sedaghat; Narges Tabrizchi
Although the error in health care has received attention recently, patient safety culture in health centers has been relatively neglected. To measure the patient safety culture in primary health centers. A cross-sectional study, utilizing the modified version of the Hospital Survey on Patient Safety Culture (HSOPSC) developed by the Agency for Healthcare Research and Quality (AHRQ) and a demographic questionnaire. Healthcare staffs from health centers were participated in the survey. The pati...
Kumar Manish; Chandu G; Shafiulla M
BACKGROUND AND OBJECTIVES : Psychiatric patients are one of the special groups requiring attention as they are often neglected. Oral health is an major determinant of general health for psychiatric patients and may have a low priority in the context of mental illness. The present study was conducted to assess the oral health status and treatment needs of institutionalized psychiatric patients of Davangere. METHODS : 220 psychiatric patients admitted in two general hospitals of Davangere durin...
Parker Whadi-ah; Steyn Nelia P; Levitt Naomi S; Lombard Carl J
Abstract Background Due to a paucity of data regarding the availability and efficacy of equipment, health promotion methods and materials currently used by health professionals for the management of patients with non-communicable diseases (NCDs) at primary health care (PHC) facilities in Cape Town, an audit was undertaken. Methods A multi-centre cross-sectional study was undertaken to interview patients (n = 580) with NCDs at 30 PHC facilities. A questionnaire was used to obtain information o...
The lack of patient engagement and clinical inertia both contribute to suboptimal diabetes care. However, both obstacles are amenable to informatics- and Internet-based interventions. The use of electronic medical records (EMRs) is now established as being useful for improving diabetes care. Intelligent records that integrate computerized decision-support systems are now able to recommend care protocols tailored to risk levels. Web-based personal health record (PHR) systems, shared with healthcare providers, could also provide added value by promoting self-management of the behaviours related to diabetes. These Web-based programmes include patients' access to EMRs, uploading of glucose monitoring results, a glucose diary, secure e-mail with providers, manual or automated feedback on blood glucose readings and other risk factors, an educational website, and an online diary for entering personal information on exercise, diet and medication. The integration of Web-based patients' systems into the EMR used by physicians is the next frontier. In addition, the input from "smartphones" that are able to provide real-time support to patients could contribute to the reorganization of diabetes care. Convincing data on HbA(1c) improvements with such systems are available for type 2 diabetes, but are still equivocal for type 1 diabetes. Obstacles include patients' compliance with the technology, their ergonomic design and the need to reimburse providers for their care. Designing appropriate electronic tools and tailoring them to the conditions in France merits our attention. PMID:22208711
Full Text Available eHealth and mHealth interventions for type 2 diabetes are emerging as useful strategies to accomplish the goal of a high functioning integrated care system. However, mHealth and eHealth interventions in order to be successful need the clear endorsement from the healthcare professionals. This cross-sectional study included a sample of 93 Italian-speaking type 2 diabetes patients and demonstrated the role of the perceived ability of healthcare professionals to motivate patients’ initiative in improving the level of their engagement and activation in type 2 diabetes self-management. The level of type 2 diabetes patients’ activation resulted also in being a direct precursor of their attitude to the use of mHealth and eHealth. Furthermore, patient engagement has been demonstrated to be a mediator of the relationship between the perceived ability of healthcare professionals in motivating type 2 diabetes patients and patients’ activation. Finally, type 2 diabetes patients adherence did not result in being a direct consequence of the frequency of mHealth and eHealth use. Patient adherence appeared to be directly influenced by the level of perceived healthcare professionals ability of motivating patients’ autonomy. These results offer important insights into the psychosocial and organizational elements that impact on type 2 diabetes patients’ activation in self-management and on their willingness to use mHealth and eHealth devices.
Eyüboğlu, Ezgi; Schulz, Peter J
Objective This study aimed to assess the impact of health literacy and patient empowerment on diabetes self-care behaviour in patients in metropolitan Turkish diabetes centres. The conceptual background is provided by the psychological health empowerment model, which holds that health literacy without patient empowerment comes down to wasting health resources, while empowerment without health literacy can lead to dangerous or suboptimal health behaviour. Design, setting and participants A cross-sectional study was conducted with 167 patients over the age of 18 from one of two diabetes clinics in a major Turkish City. Self-administered questionnaires were distributed to eligible outpatients who had an appointment in one of the clinics. Health literacy was measured by a newly translated Turkish version of the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Chew self-report scale. Patient empowerment was measured by a 12-item scale based on Spreitzer's conceptualisation of psychological empowerment in the workplace. Self-care behaviour was measured by the Self-care behaviours were measured by the Summary of Diabetes Self-Care Activities Measure (SDSCA). Level of diabetes knowledge was measured by Diabetes Knowledge Test. Results Two subscales of empowerment, impact and self-determination, predicted self-reported frequency of self-care behaviours. Neither health literacy nor diabetes knowledge had an effect on self-care behaviours. Conclusions Health literacy might be more effective in clinical decisions while empowerment might exert a stronger influence on habitual health behaviours. PMID:26975936
When people are ill, they want to know what is happening to them and how they can get better. Current health policies support patients' access to health information and encourage them to take part in decisions regarding their health. But little is known about how patients learn and the difficulties they may encounter in the process. This paper…
Leonardo Naves dos Reis
Full Text Available The objective of this study is to evaluate the factors of prediction (diagnostic and socio- demographic characteristics regarding psychiatric outpatient mental health among users. The study was conducted from secondary data, extracted from the charts and analyzed through logistic regression, to obtain the prediction equation of probability of psychiatric hospitalization. The diagnoses that showed statistical significance (p < 0.05 were bipolar affective disorder, schizophrenia, anxious disorders and depression, and the first two showed a high magnitude association with the need of hospitalization. The age was inversely proportional to the need of hospitalization. The results found may stimulate specific actions and the psychiatric prevention of younger patients with schizophrenia and bipolar affective disorder.
Full Text Available Background: Patients often complain about their doctor′s attitude toward them. They describe the interaction that they have with some doctors as quick, cold, discourteous, or hardhearted. Although this does not apply to all Lebanese doctors, it does apply to some. Aims: The purpose of this study was to (1 examine the general perception of satisfaction, trust, and openness that Lebanese patients hold toward the work, office, personal, and social characteristics of their doctors - physician or dentist; and (2 identify the aspects on which a Lebanese health practitioner should focus to improve his/her practice. Materials and Methods: A convenient sample of 450 individuals from an area housing nine hospitals and hundreds of private clinics in Greater Beirut were surveyed regarding the qualities of their health practitioners. They were asked to complete a nine-page, 85-item, anonymous, and voluntary questionnaire that dealt with the medical and dental practice in Lebanon. Participants were older than 18 years and mentally competent. None was physicians, dentists, or nurses. The questionnaire was open-ended and initially pretested and piloted among a random sample. Results: Four hundred-fifteen (92% individuals responded. Participants were from different ages, genders, geographical areas, educational backgrounds, and professions. The doctor traits most preferred by the Lebanese public were found to be: Empathy (90%, professionalism (87%, miscellaneous traits (86%, and academics (81%. Conclusion: The results support the conventional wisdom that the idealized perception of a doctor as a care-giving, compassionate, knowledgeable, well-appearing, and healthy role model still holds true within the Lebanese community.
Xie, Bo; Wang, Mo; Feldman, Robert; Zhou, Le
Background The Internet is bringing fundamental changes to medical practice through improved access to health information and participation in decision making. However, patient preferences for participation in health care vary greatly. Promoting patient-centered health care requires an understanding of the relationship between Internet use and a broader range of preferences for participation than previously measured. Objective To explore (1) whether there is a significant relationship between...
Martinez, Phillip Rico
Background: For over 17 years, the Prevention and Access to Care and Treatment (PACT) Project has actively developed a Community Health Worker model for care of chronically ill, high risk patients. Given the high burden of chronic disease and associated rising health expenditures, mHealth technology has emerged as a promising low cost, high efficacy intervention for delivery of patient-centered care and as a tool for self-management of chronic disease Objective: Attitudes and perceptions r...
Koumaditis, Konstantinos; Themistocleous, Marinos; Vassilacopoulos, George; Prentza, Andrianna; Kyriazis, Dimosthenis; Malamateniou, Flora; Maglaveras, Nicos; Chouvarda, Ioanna; Mourouzis, Alexandros
The purpose of this paper is to introduce the Patient-Centered e-Health (PCEH) conceptual aspects alongside a multidisciplinary project that combines state-of-the-art technologies like cloud computing. The project, by combining several aspects of PCEH, such as: (a) electronic Personal Healthcare Record (e-PHR), (b) homecare telemedicine technologies, (c) e-prescribing, e-referral, e-learning, with advanced technologies like cloud computing and Service Oriented Architecture (SOA), will lead to an innovative integrated e-health platform of many benefits to the society, the economy, the industry, and the research community. To achieve this, a consortium of experts, both from industry (two companies, one hospital and one healthcare organization) and academia (three universities), was set to investigate, analyse, design, build and test the new platform. This paper provides insights to the PCEH concept and to the current stage of the project. In doing so, we aim at increasing the awareness of this important endeavor and sharing the lessons learned so far throughout our work. PMID:25000049
Full Text Available BACKGROUND: Despite the increase in the awareness of Epilepsy, still people are not much aware of the oral health complications related to the intake of antiepileptic drugs. OBJECTIVE: To assess the most common oral health problems that people face while using the Anti-epileptic drugs and hence forth decide its remedy. To make people aware of the potential side effects of using the anti-epileptic drugs. MATERIALS AND METHODS: This study was conducted on 200 epileptic patients who were on anti-epileptic medication for one year or more. The study was conducted at Government Hospital in Ratan nagar dist churu. RESULTS: Gingival hyperplasia was seen as a common side effects of the Anti-epileptic Drug. Lips and cheek biting were the most common soft tissue injury, while tooth fracture was the most common hard tissue dental injury. CONCLUSION: General physicians and dentist should be well aware of the potential side effects of Anti-epileptic Drugs. A dentist should be well versed and trained to manage oro-facial injuries in the emergency department.
Meltem Daysal, N.
Abstract: In this paper, I examine the impact of uninsured patients on the health of the insured, focusing on one health outcome - the in-hospital mortality rate of insured heart attack patients. I employ panel data models using patient discharge and hospital financial data from California (1999-200
... safety, prevention, population health, patient engagement, patient experience, and efficient resource use... Department of Health and Human Services (the Secretary) holds primary responsibility for establishing the... performance data for the QRS in general topics, such as clinical effectiveness of care, patient safety,...
... organizations whose mission and primary activity is to conduct activities to improve patient safety and the quality of health care delivery. HHS issued the Patient Safety Rule to implement the Patient Safety Act... collect, aggregate, and analyze confidential information regarding the quality and safety of health...
Background Scholars describe poor health literacy as a “silent epidemic,” which is challenging the functioning of healthcare systems all over the world. Health literacy is mainly meant as an individual trait which concerns the ability to obtain, process, and understand basic health information in order to effectively navigate the health system. Low health literate patients perceive poor self-efficacy dealing with their health conditions, are not willing to be involved in the provision of ...
Jayasinghe, Upali W; Harris, Mark Fort; Parker, Sharon M.; Litt, John; van Driel, Mieke; Mazza, Danielle; Del Mar, Chris; Lloyd, Jane; Smith, Jane; Zwar, Nicholas; Taylor, Richard; ,
Background Limited evidence exists regarding the relationship between health literacy and health-related quality of life (HRQoL) in Australian patients from primary care. The objective of this study was to investigate the impact of health literacy on HRQoL in a large sample of patients without known vascular disease or diabetes and to examine whether the difference in HRQoL between low and high health literacy groups was clinically significant. Methods This was a cross-sectional study of base...
... Task Force Improving Primary Care Practice Health IT Integration Health Care/System Redesign Clinical-Community Linkages Care Coordination Capacity Building Behavioral and Mental Health Self-Management Support Resources Clinical Community Relationships ...
Lettieri, Emanuele; Fumagalli, Lia P.; Radaelli, Giovanni; Bertele’, Paolo; Vogt, Jess; Hammerschmidt, Reinhard; Lara, Juan L.; Carriazo, Ana; Masella, Cristina
Background This paper crystallises the experience developed by the pan-European PALANTE Consortium in dealing with the generation of relevant evidence from heterogeneous eHealth services for patient empowerment in nine European Regions. The European Commission (EC) recently funded a number of pan-European eHealth projects aimed at empowering European patients/citizens thus transforming the traditional patient/citizen role in the management of their health (e.g., PALANTE, SUSTAIN, CARRE, Heart...
Pullinger, W.; Franklin, B. D.
Objectives We aimed to identify potential barriers to hospital pharmacists' documentation in patients' hospital health records, and to explore pharmacists' training needs. Our objectives were to identify the methods used by pharmacists to communicate and document patient care issues, to explore pharmacists' attitudes towards documentation of patient care issues in health records, to identify and examine the factors influencing whether or not pharmacists document their care in health records a...
Robotham, D.; Waterman, S.; Oduola, S; Papoulias, C.; Craig, T; Wykes, T.
OBJECTIVES: Research registers using Consent for Contact (C4C) can facilitate recruitment into mental health research studies, allowing investigators to contact patients based on clinical records information. We investigated whether such a register was useful for mental health research, seeking the perspectives of patients and research investigators.SETTING AND DESIGN: In 2012, a C4C register was developed in a large secondary mental health provider within the UK; almost 9000 patients have jo...
Lam, Chun Nok; Arora, Sanjay; Menchine, Michael
Background: Patients with mental health conditions frequently use emergency medical services. Many suffer from substance use and homelessness. If they utilize the ED as their primary source of care, potentially preventable frequent ED revisits and hospital readmissions can worsen an already over-crowded health care system. However, the magnitude to which homelessness affects health service utilization among patients with mental health conditions remains unclear in the medical community. This...
Young Rodney; Rohrer James E
Abstract Background The independent effects of stress on the health of primary care patients might be different for different types of clinic populations. This study examines these relationships in a low-income female population of patients attending a family planning clinic. Methods This study investigated the relevance of different sources of personal stress and social support to self-rated health, adjusting for mental health, health behavior and demographic characteristics of subjects. Fiv...
Hørdam, Britta; Hemmingsen, Lars
Background: THR is as a very efficient operation in terms of pain-relief and improvement of walking ability. However, after the operation some patients still report low health status. Aim: The aim of the study is to describe health status among the patients following THR and to identify factors...... measures eight domains of importance for health status. The measures are physical function, role physical, bodily pain, social function, role emotional, general health, vitality and mental health. Results: Patients living alone or being depend on help from others had a significantly increased risk of...
Vanessa Damiana Menis Sasaki
Full Text Available The study aimed to identify the profile of ostomy patients in a Health Care Service in São José do Rio Preto, São Paulo, Brazil. This is an exploratory, descriptive and retrospective study. Data were obtained by registration forms of patients assisted from January 1st, 2000, to December 31st, 2010. Out of the 252 ostomy patients, 51.1% were females and 48.9% were males; the age group with the highest concentration was from 68 to 78 years old (26.3% for both genders, with mean age of 73 years old. The main reason for making the stoma was rectal (35.0% and colon neoplasm (14.1%. The prevalent stoma was temporary colostomy (41.4% and the period of permanence of the collecting equipment was longer than 36 months. Even though the service provides full assistance to the ostomy patients, it is necessary to review human resources aspects to provide appropriate assistance to its clientele.O estudo teve como objetivo identificar o perfil de pacientes estomizados de um Serviço de Atenção ao Estomizado de São José do Rio Preto e Região. A pesquisa é exploratória, descritiva e retrospectiva. Os dados foram obtidos das fichas cadastrais dos pacientes atendidos no período de 1º de janeiro de 2000 a 31 de dezembro de 2010. Dos 252 estomizados, 51,1% eram mulheres e 48,9% homens, a faixa etária de maior concentração encontrou-se, em ambos os sexos, entre 68 a 78 anos (26,3% com média de idade de 73 anos. O principal motivo da confecção do estoma foi a neoplasia de reto (35,0% e cólon (14,1%. O estoma prevalente foi a colostomia temporária (41,4% e o tempo de permanência do equipamento coletor foi superior a 36 meses. O Serviço, embora proporcione assistência integral ao estomizado, necessita rever aspectos de recursos humanos à assistência adequada à clientela.
Magrabi, Farah; Ong, Mei-Sing; Coiera, Enrico
Alongside their benefits health IT applications can pose new risks to patient safety. Problems with IT have been linked to many different types of clinical errors including prescribing and administration of medications; as well as wrong-patient, wrong-site errors, and delays in procedures. There is also growing concern about the risks of data breach and cyber-security. IT-related clinical errors have their origins in processes undertaken to design, build, implement and use software systems in a broader sociotechnical context. Safety can be improved with greater standardization of clinical software and by improving the quality of processes at different points in the technology life cycle, spanning design, build, implementation and use in clinical settings. Oversight processes can be set up at a regional or national level to ensure that clinical software systems meet specific standards. Certification and regulation are two mechanisms to improve oversight. In the absence of clear standards, guidelines are useful to promote safe design and implementation practices. Processes to identify and mitigate hazards can be formalised via a safety management system. Minimizing new patient safety risks is critical to realizing the benefits of IT. PMID:27198089
Bilal, Arebu I.; Osman, Ebrahim D.; Mulugeta, Anwar
Background About one-third of the world’s population lack access to essential medicines and this is further compounded by inappropriate prescription, dispensing, sale and use of the available medicines. The objective of the study was to assess the patterns of medicine use among health facilities in eastern Ethiopia using World Health Organization’s Prescribing, Patient Care and Health facility indicators. Methods A cross sectional study was carried out in eight randomly selected health center...
Huh, Jina; Hartzler, Andrea; Munson, Sean; Anderson, Nick; Edwards, Kelly; Gore, John L.; McDonald, David; O’Leary, Jim; Parker, Andrea; Streat, Derek; Yetisgen-Yildiz, Meliha; Pratt, Wanda; Ackerman, Mark S.
Researchers and practitioners show increasing sinterest in utilizing patient-generated information on the Web. Although the HCI and CSCW communities have provided many exciting opportunities for exploring new ideas and building broad agenda in health, few venues offer a platform for interdisciplinary and collaborative brainstorming about design challenges and opportunities in this space. The goal of this workshop is to provide participants with opportunities to interact with stakeholders from diverse backgrounds and practices—researchers, practitioners, designers, programmers, and ethnographers—and together generate tangible design outcomes that utilize patient-generated information on the Web. Through small multidisciplinary group work, we will provide participants with new collaboration opportunities, understanding of the state of the art, inspiration for future work, and ideally avenues for continuing to develop research and design ideas generated at the workshop. PMID:24499843
Rademakers, J.; Nijman, J.; Brabers, A.E.M.; Jong, J.D. de; Hendriks, M.
Active provider choice by patients has become an important policy theme in western, countries over the last decades. However, not many patients and consumers exercise their rightto, choose. Both health literacy and patient activation are likely to have an impact on the choiceprocess.In,this article the relative effect of health literacy and patient activation on provider choice in the, Netherlands is studied. A questionnaire was sentto a representative sample of 2000 Dutch citizens. The quest...
Huynh, Ho Phi
Effective clinicians need to motivate their patients to initiate and maintain beneficial health behaviors. Using transformational leadership theory as the theoretical framework, we proposed that clinicians' motivational behaviors can be organized into three "doctorship styles," or patterned approaches to patient care: passive-avoidant, transactional, and transformational. We also suggested that the styles differentially predict patient health outcomes. In Study 1, we used patient-reported que...
Herman, Patricia M; Ingram, Maia; Rimas, Heather; Carvajal, Scott; Cunningham, Charles E
We used a discrete-choice conjoint experiment to model the mental health services preferences of patients of a federally-qualified health center serving a primarily low-income, Hispanic farmworker population in southwestern Arizona. The two attributes that had the largest influence on patient choices (i.e., received the highest importance scores) were where patients receive these services and the language and cultural awareness of the provider who prescribed their treatment. Simulations indicated that the clinic could substantially improve its patients' welfare with even a single change. The single most effective change in terms of patient preferences would be to offer behavioral health services onsite. PMID:26410547
Gianoukakis AG; Flores NM; Pelletier CL; Forsythe A; Wolfe GR; Taylor MH
Andrew G Gianoukakis,1 Natalia M Flores,2 Corey L Pelletier,3 Anna Forsythe,3 Gregory R Wolfe,2 Matthew H Taylor41Division of Endocrinology and Metabolism, Harbor-UCLA Medical Center, The University of California, Los Angeles, 2Health Outcomes Research, Kantar Health, Foster City, CA, 3Global Value and Access, Eisai, Inc., Woodcliff Lakes, NJ, 4Division of Hematology and Medical Oncology, Oregon Health and Science University, Portland, OR, USABackground: Patients with differentiated thyroid c...
Patient and citizen participation is now regarded as central to the promotion of sustainable health and health care. Involvement efforts create and encounter many diverse ethical challenges that have the potential to enhance or undermine their success. This article examines different expressions of patient and citizen participation and the support health ethics offers. It is contended that despite its prominence and the link between patient empowerment and autonomy, traditional bioethics is insufficient to guide participation efforts. In addition, the turn to a "social paradigm" of ethics in examinations of biotechnologies and public health does not provide an account of values that is commensurable with the pervasive autonomy paradigm. This exacerbates rather than eases tensions for patients and citizens endeavoring to engage with health. Citizen and patient participation must have a significant influence on the way we do health ethics if its potential is to be fulfilled. PMID:24809598
MD. NURUL HUDA
Full Text Available Patient-controlled personal health record systems can help make health care safer, cheaper, and more convenient by facilitating patients to 1 grant any care provider access to their complete personal health records anytime from anywhere, 2 avoid repeated tests and 3 control their privacy transparently. In this paper, we present the architecture of our Privacy-aware Patient-controlled Personal Health Record (P3HR system through which a patient can view her integrated health history, and share her health information transparently with others (e.g., healthcare providers. Access to the health information of a particular patient is completely controlled by that patient. We also carry out intuitive security and privacy analysis of the P3HR system architecture considering different types of security attacks. Finally, we describe a prototype implementation of the P3HR system that we developed reflecting the special view of Japanese society. The most important advantage of P3HR system over other existing systems is that most likely P3HR system provides complete privacy protection without losing data accuracy. Unlike traditional partially anonymous health records (e.g., using k-anonymity or l-diversity, the health records in P3HR are closer to complete anonymity, and yet preserve data accuracy. Our approach makes it very unlikely that patients could be identified by an attacker from their anonymous health records in the P3HR system.
Øyeflaten, Irene; Gabriele, Jeanne M; Fisher, Edwin B.; Eriksen, Hege R.
Objectives: To examine differences in rehabilitation patients' social support received from rehabilitation staff and from support providers outside rehabilitation, and to examine the relationships between social support and the patients' reports of subjective health complaints (SHC). Methods: 131 patients (68 % females, mean age 45 years) participating in a 4-week, inpatient, occupational rehabilitation program were included. All patients completed questionnaires on demographic variables, SHC...
Kahiga Joseph Kiruki
Full Text Available The aim of this study is to highlight the importance of healthcare ethics in addressing the alleviation of the suffering of the poor and sick patients by healthcare givers. One’s social, economic status, class, race, tribe, clan and gender become variables of branding or giving diminutive attributes to those different from ‘us’. Those ‘others’ are the most disadvantaged to the level that they are regarded as ‘things’ or ‘objects’ instead of humans or ‘subjects’ with dignity. The study seeks to unveil the mindset that is behind the suffering of the ‘others’ who are basically the poor and the sick and suggest the way forward in re-establishing the dignity of a person irrespective of the social status, class, race or gender and health condition. Through modern advancement in medical technology, we have made an attempt to vanquish all diseases and postpone death indefinitely to the advantage of the rich who can afford it while the poor die in droves from preventable and curable diseases. Our assumptions and perceptions make the foundation upon which we act thereby laying bare our ‘value systems’. The study focuses on healthcare ethics and will use a rational critical discourse to arrive at the conclusions. We use Martin Buber’s concept of the ‘I-Thou’ relationship as our conceptual framework that assists to contextualize the healthcare ethics in the consideration of the healthcare giver as the ‘I’ and the patient as the ‘Thou’. The Christian Scriptures form the basis upon which healthcare givers find the foundation of their values and actions. A human being irrespective of status is a subject ‘I’ and is the image of God who is the ‘Thou’. This relationship ought to be contextualized in interpersonal healthcare network forming an ‘IThou’ link between healthcare giver and patient thereby delivering quality healthcare service without discrimination on the basis of ‘status’ or class.
In this article, guest writer Ivana Truccolo presents an overview of her work at the Scientific and Patient Library of a Cancer Comprehensive Centre in Italy coordinating the patient education process. She discusses the historical evolution of the concept of patient education and how this has run alongside the role of the health librarian in the provision of consumer health information. Details are provided about various patient education programmes in place at the Centre. In particular, various activities are discussed including patient education classes, the development of patient education handouts and a narrative medicine programme which includes a literary competition. The article concludes with a specific outline of the role the health librarian can play in the provision of consumer health information and patient education. H.S. PMID:27168259
Full Text Available Background: Depression is common among diabetes, and is associated with poor outcomes. However, the data on this important relationship are limited from India. Objective: The aim was to estimate the prevalence of depression in patients with diabetes and to determine the association of depression with age, sex, and other related parameters. Materials and Methods: The study was cross-sectional carried out in endocrinology clinic of tertiary care hospital in North India. Cases were patients with type 2 diabetes mellitus (T2DM above 30 years of age. Depression was assessed using the patient health questionairre-9 (PHQ-9. The relationship with sociodemographic profile, duration of diabetes, hypertension and microvascular complications was also analyzed. Results: Seventy-three subjects (57.5% females with mean age 50.8 ± 9.2 years were evaluated. The prevalence of depression was 41%. Severe depression (PHQ score ≥15 was present in 3 (4% subjects, moderate depression (PHQ score ≥10 in 7 (10% subjects, and mild depression was present in 20 (27% of subjects. Depression was significantly more prevalent in rural subjects (57% when compared to urban ones (31%, P = 0.049. Depression increased with presence of microvascular complications, fasting plasma glucose, hypertension, but the differences were not statistically significant. Conclusions: Our study demonstrates higher prevalence of depression in patients with type 2 diabetes. Apart from being belonging to the rural area, no other factor was significantly associated with depression. Therefore, depression should be assessed in each and every patient, irrespective of other factors.
Full Text Available Abstract Background Costa Rica, like other developing countries, is experiencing an increasing burden of chronic conditions such as diabetes mellitus (DM, especially among its elderly population. This article has two goals: (1 to assess the level of metabolic control among the diabetic population age ≥ 60 years old in Costa Rica, and (2 to test whether diabetic elderly patients of community health centers differ from patients in other health care settings in terms of the level of metabolic control. Methods Data come from the project CRELES, a nationally representative study of people aged 60 and over in Costa Rica. This article analyzes a subsample of 542 participants in CRELES with self-reported diagnosis of diabetes mellitus. Odds ratios of poor levels of metabolic control at different health care settings are computed using logistic regressions. Results Lack of metabolic control among elderly diabetic population in Costa Rica is described as follows: 37% have glycated hemoglobin ≥ 7%; 78% have systolic blood pressure ≥ 130 mmHg; 66% have diastolic blood pressure ≥ 80 mmHg; 48% have triglycerides ≥ 150 mg/dl; 78% have LDL ≥ 100 mg/dl; 70% have HDL ≤ 40 mg/dl. Elevated levels of triglycerides and LDL were higher in patients of community health centers than in patients of other clinical settings. There were no statistical differences in the other metabolic control indicators across health care settings. Conclusion Levels of metabolic control among elderly population with DM in Costa Rica are not that different from those observed in industrialized countries. Elevated levels of triglycerides and LDL at community health centers may indicate problems of dyslipidemia treatment among diabetic patients; these problems are not observed in other health care settings. The Costa Rican health care system should address this problem, given that community health centers constitute a means of democratizing access to primary health care to
Karazivan, Philippe; Dumez, Vincent; Flora, Luigi; Pomey, Marie-Pascale; Del Grande, Claudio; Ghadiri, Djahanchah Philip; Fernandez, Nicolas; Jouet, Emmanuelle; Las Vergnas, Olivier; Lebel, Paule
The prevalence of chronic diseases today calls for new ways of working with patients to manage their care. Although patient-centered approaches have contributed to significant advances in care and to treatments that more fully respect patients' preferences, values, and personal experiences, the reality is that health care professionals still hold a monopoly on the role of healer. Patients live with their conditions every day and are experts when it comes to their own experiences of illness; this expertise should be welcomed, valued, and fostered by other members of the care team. The patient-as-partner approach embodies the ideal of making the patient a bona fide member of the health care team, a true partner in his or her care. Since 2010, the University of Montreal, through the Direction of Collaboration and Patient Partnership, has embraced this approach. Patients are not only active members of their own health care team but also are involved in research and provide valuable training to health sciences students. Including patients as full partners in the health care team entails a significant shift in both the medical practice and medical education cultures. In this perspective, the authors describe this innovative approach to patient care, including the conceptual framework used in its development and the main achievements of patient partners in education, health care, and research. PMID:25607943
Robert John Adams
Robert John AdamsThe Health Observatory, The Queen Elizabeth Hospital Campus, The University of Adelaide, Woodville, South Australia, AustraliaAbstract: A central plank of health care reform is an expanded role for educated consumers interacting with responsive health care teams. However, for individuals to realize the benefits of health education also requires a high level of engagement. Population studies have documented a gap between expectations and the actual performance of behaviours re...
A new class of patient-driven health care services is emerging to supplement and extend traditional health care delivery models and empower patient self-care. Patient-driven health care can be characterized as having an increased level of information flow, transparency, customization, collaboration and patient choice and responsibility-taking, as well as quantitative, predictive and preventive aspects. The potential exists to both improve traditional health care systems and expand the concept...
Smith, Timothy R; Rambachan, Aksharananda; Cote, David; Cybulski, George; Laws, Edward R
: The US health care system is struggling with rising costs, poor outcomes, waste, and inefficiency. The Patient Protection and Affordable Care Act represents a substantial effort to improve access and emphasizes value-based care. Value in health care has been defined as health outcomes for the patient per dollar spent. However, given the opacity of health outcomes and cost, the identification and quantification of patient-centered value is problematic. These problems are magnified by highly technical, specialized care (eg, neurosurgery). This is further complicated by potentially competing interests of the 5 major stakeholders in health care: patients, doctors, payers, hospitals, and manufacturers. These stakeholders are watching with great interest as health care in the United States moves toward a value-based system. Market principles can be harnessed to drive costs down, improve outcomes, and improve overall value to patients. However, there are many caveats to a market-based, value-driven system that must be identified and addressed. Many excellent neurosurgical efforts are already underway to nudge health care toward increased efficiency, decreased costs, and improved quality. Patient-centered shared value can provide a philosophical mooring for the development of health care policies that utilize market principles without losing sight of the ultimate goals of health care, to care for patients. PMID:26308640
Full Text Available Abstract Background Due to a paucity of data regarding the availability and efficacy of equipment, health promotion methods and materials currently used by health professionals for the management of patients with non-communicable diseases (NCDs at primary health care (PHC facilities in Cape Town, an audit was undertaken. Methods A multi-centre cross-sectional study was undertaken to interview patients (n = 580 with NCDs at 30 PHC facilities. A questionnaire was used to obtain information on preferences for health promotion methods for lifestyle modification. Individual semi-structured interviews were conducted with selected health professionals (n = 14 and captured using a digital recorder. Data were transferred to the Atlas ti software programme and analysed using a thematic content analysis approach. Results Blood pressure measurement (97.6% was the most common diagnostic test used, followed by weight measurement (88.3%, urine (85.7% and blood glucose testing (80.9%. Individual lifestyle modification counselling was the preferred health education method of choice for the majority of patients. Of the 64% of patients that selected chronic clubs/support groups as a method of choice, only a third rated this as their first choice. Pamphlets, posters and workshops/group counselling sessions were the least preferred methods with only 9%, 13% and 11% of patients choosing these as their first choice, respectively. In an individual counselling setting 44.7% of patients reported that they would prefer to be counselled by a doctor, followed by a nurse (16.9%, health educator (8.8% and nutrition advisor (4.8%. Health professionals identified numerous barriers to education and counselling. These can be summarised as a lack of resources, including time, space and equipment; staff-related barriers such as staff shortage and staff turnover; and patient-related barriers such as patient load and patient non-compliance. Conclusion The majority of patients
Self-rated health (SRH) and Quality of Life (QoL) have become very fashionable in medical research and patient care in the past two decades. The frequency of medical publications on these topics has expanded exponentially since the 1980s. Patient-reported self-evaluations, in particular on health-re
Alexander, Lisa Mustone
The physician assistant (PA) has been on the leading edge in the development of midlevel health providers since the 1960s. As an allied health professional, PAs, along with nurse practitioners, midwives, nurse anesthetists, and others, emphasize patient education. Oftentimes, patient education can be introduced in the academic setting, but true learning comes with experience as a student in clinical training.
textabstractHealth related quality of life (HRQOL) is a relevant outcome measure for patients admitted to the intensive care unit (ICU). Long term outcome for physical and psychological factors, functional status and social interactions are becoming more and more important both for doctors and nurses as well as for patients and their relatives (1;2). Therefore doctors and nurses want to know what a “reasonable” quality of life means to their patients. The main reason for HRQOL research descri...
In the United States, the ability to understand English plays an essential role in how well patients and health-care providers communicate. This article highlights the concerns of providers, differential health-care outcomes, and risk management concerns of providing health care in an increasingly diverse and polyglot population. PMID:15500018
Xu, L. J.; Meng, Q.; He, S. W.; Yin, X. L.; Tang, Z. L.; Bo, H. Y.; Lan, X. Y.
Objective: This study collected on from all research relating to health education and hypertension in China and, with the aid of meta-analysis tools, assessed the outcomes of such health education. The analysis provides a basis for the further development of health-education programmes for patients with hypertension. Methods: Literature searches…
McCallum, Stacey L; Andrews, Jane M; Gaughwin, Matthew D; Turnbull, Deborah A; Mikocka-Walus, Antonina A
Background Previous studies suggest patients with co-occurring alcohol use disorders (AUDs) and severe mental health symptoms (SMHS) are less satisfied with standard AUD treatment when compared to patients with an AUD alone. This study compared patient satisfaction with standard AUD treatment among patients with and without SMHS and explored how standard treatment might be improved to better address the needs of these patients. Methods Eighty-nine patients receiving treatment for an AUD either at an inpatient hospital, outpatient clinic, inpatient detoxification, or residential/therapeutic community services were surveyed. Patient satisfaction with treatment was assessed using the Treatment Perception Questionnaire (range: 0–40). Patients were stratified according to their score on the Depression Anxiety Stress Scale. Forty patients scored in the extremely severe range of depression (score >14) and/or anxiety (score >10) (indicating SMHS) and 49 patients did not. An inductive content analysis was also conducted on qualitative data relating to areas of service improvement. Results Patients with SMHS were found to be equally satisfied with treatment (mean =25.10, standard deviation =8.12) as patients with an AUD alone (mean =25.43, standard deviation =6.91). Analysis revealed that being an inpatient in hospital was associated with reduced treatment satisfaction. Patients with SMHS were found to be significantly less satisfied with staffs’ understanding of the type of help they wanted in treatment, when compared to patients with AUDs alone. Five areas for service improvement were identified, including staff qualities, informed care, treatment access and continuity, issues relating to inpatient stay, and addressing patients’ mental health needs. Conclusion While findings suggest that AUD treatment services adequately meet the needs of patients with SMHS in treatment, patients with SMHS do feel that staff lack understanding of their treatment needs. Findings have
Martire, Lynn M.; Keefe, Francis J.; Stephens, Mary Ann Parris; Schulz, Richard
Background In addition to patient self-efficacy, spouse confidence in patient efficacy may also independently predict patient health outcomes. However, the potential influence of spouse confidence has received little research attention. Purpose The current study examined the influence of patient and spouse efficacy beliefs for arthritis management on patient health. Methods Patient health (i.e., arthritis severity, perceived health, depressive symptoms, lower extremity function), patient self-efficacy, and spouse confidence in patients’ efficacy were assessed in a sample of knee osteoarthritis patients (N = 152) and their spouses at three time points across an 18-month period. Data were analyzed using structural equation models. Results Consistent with predictions, spouse confidence in patient efficacy for arthritis management predicted improvements in patient depressive symptoms, perceived health, and lower extremity function over 6 months and in arthritis severity over 1 year. Conclusions Our findings add to a growing literature that highlights the important role of spouse perceptions in patients’ long-term health. PMID:24604529
Sodani Prahlad; Kumar Rajeev; Srivastava Jayati; Sharma Laxman
Objective: The main objective of the study is to measure the satisfaction of OPD (Outpatient Department) patients in public health facilities of Madhya Pradesh in India. Materials and Methods: Data were collected from OPD patients through pre-structured questionnaires at public health facilities in the sampled eight districts of Madhya Pradesh. The data were analyzed using SPSS. Settings: Outpatient Departments of district hospital, civil hospital, community health centre, and primary ...
Brettschneider, Christian; Lühmann, Dagmar; Raspe, Heiner
Background "Patient-Reported Outcome" (PRO) is used as an umbrella term for different concepts for measuring subjectively perceived health status e. g. as treatment effects. Their common characteristic is, that the appraisal of the health status is reported by the patient himself. In order to describe the informative value of PRO in Health Technology Assessment (HTA) first an overview of concepts, classifications and methods of measurement is given. The overview is complemented by an empir...
Rosdahl, Jullia A; Suzanne Schneider; Anita P. Vin
Introduction: Successful medical treatment of glaucoma requires adherence to daily eye drop medications. Health coaching, which has been used successfully for other chronic diseases, may be helpful for glaucoma patients. Methods: Qualitative analysis of pre-coaching questionnaire, coaching notes, and post-coaching exit interviews, for four glaucoma patients who completed a 6-month health coaching interventional study. The health coaching intervention consisted of 4-6 coachin...
Mosher, Catherine E.; Given, Barbara A.; Ostroff, Jamie S.
Although family caregivers of patients with lung and other cancers show high rates of psychological distress, they underuse mental health services. This qualitative study aimed to identify barriers to mental health service use among 21 distressed family caregivers of lung cancer patients. Caregivers had not received mental health services during the patient’s initial months of care at a comprehensive cancer centre in New York City. Thematic analysis of interview data was framed by Andersen’s ...
Abredari, Hamid; Bolourchifard, Fariba; Rassouli, Maryam; Nasiri, Navideh; Taher, Mohammad; Abedi, Ahmadreza
Background: Diabetic foot affects more than 25% of diabetic patients and finally up to 20% of cases result in amputation. The most important factor resulting in severe complications or even death is lack of self-care. Health locus of control has been introduced as one of health factors and predicting factors of self-care. This research was performed for analyzing the correlation between self-care behaviors and health locus of control in diabetic foot patients. Methods: In this descriptive stu...
Molsted, Stig; Prescott, Lotte; Heaf, James;
BACKGROUND/AIMS: It is relevant to investigate health-related quality of life (HRQOL) in dialysis and chronic kidney disease (CKD) patients in order to optimise treatment. The aim of this study was to investigate HRQOL in dialysis and CKD patients, to compare results from patients treated with...... control parameters were measured and the patients completed the questionnaire Kidney Disease Quality Of Life. RESULTS: PD patients rated Dialysis Staff Encouragement and Patient Satisfaction better than HD patients (p< or = 0.05). Dialysis patients scored significant lower than the general population in...... hemodialysis (HD) and peritoneal dialysis (PD) and to investigate the prediction of dialysis quality control parameters (blood hemoglobin, plasma albumin, and Kt/V) and tobacco smoking in disease-specific HRQOL. METHODS: Seventy-one HD, 59 PD, and 63 CKD patients participated in the study. Dialysis quality...
Full Text Available Background Scholars describe poor health literacy as a “silent epidemic,” which is challenging the functioning of healthcare systems all over the world. Health literacy is mainly meant as an individual trait which concerns the ability to obtain, process, and understand basic health information in order to effectively navigate the health system. Low health literate patients perceive poor self-efficacy dealing with their health conditions, are not willing to be involved in the provision of care, show larger risks of hospitalization and mortality, and are not aware about the determinants of well-being. Hence, limited health literacy has been associated with inadequate management of long-term conditions; nonetheless, several authors argue that health literacy has been an overlooked factor dealing with HIV. Methods This study is aimed at discussing the effects of poor health literacy on people living with HIV, drawing from the findings of a narrative literature review which involved 41 papers retrieved from the databases “Scopus-Elsevier” and “PubMed.” Results The scientific literature is not consistent dealing with the relationship between health literacy and HIV treatment. For example, health literate patients seem to better understand their health conditions; on the other hand, people living with poor health literacy are likely to report higher compliance with providers’ prescriptions, blindly trusting healthcare professionals. Conclusions Poor health literacy is a social barrier to access healthcare services and to appropriate health treatment among patients living with HIV. Tailored interventions should be aimed at enhancing the health skills of patients affected by HIV infection to improve their ability to navigate the health system.
Background Whether health literacy is independently associated with processes or outcomes of diabetes-related care is controversial. We tried to demonstrate the interaction of health literacy and understanding of health education and instructions in achieving glycemic control. Methods Five hundred and one consecutive patients with type 2 diabetes mellitus (DM) in the outpatient clinic of the metabolism department were recruited into this pilot study. The demographic data were collected from patients’ self-reports. The clinical background information was collected through electronic medical records. A questionnaire derived from part of the Mandarin Health Literacy Scale was used to measure numeracy and functional health literacy of people with diabetes. Health literacy levels were categorized into inadequate, marginal and adequate. Patient self-ratings of their perceived understanding of the health education information and instructions provided by their case manager in the past were categorized into two subgroups: better and poor. Patients with an HbA1c level equal to or below 7% were considered to have good glycemic control. Multivariate logistic regression was used to find associated factors of health literacy and understanding of health education and instructions. GENMOD procedures were used to analyze repeated outcome measurements of glycemic control. Results Higher educational attainment and higher household income (odds ratios were 2.23 and 2.22, respectively) were significantly associated with patients who had adequate health literacy. Higher educational attainment and patients with a family history of DM (odds ratios were 4.99 and 1.85, respectively) were significantly associated with better understanding of health education and instructions. Adequate health literacy is not the only factor associated with good glycemic control. The effect of adequate health literacy in achieving good glycemic control might be masked by patients with better understanding
Full Text Available Objective: The main objective of the study is to measure the satisfaction of OPD (Outpatient Department patients in public health facilities of Madhya Pradesh in India. Materials and Methods: Data were collected from OPD patients through pre-structured questionnaires at public health facilities in the sampled eight districts of Madhya Pradesh. The data were analyzed using SPSS. Settings: Outpatient Departments of district hospital, civil hospital, community health centre, and primary health centre of the eight selected districts of Madhya Pradesh. Results: A total of 561 OPD patients were included in the study to know their perceptions towards the public health facilities, choosing health facility, registration process, basic amenities, perception towards doctors and other staff, perception towards pharmacy and dressing room services. It was found that most of the respondents were youth and having low level of education. The major reason of choosing the public health facility was inexpensiveness, infrastructure, and proximity of health facility. Measuring patient satisfaction were more satisfied with the basic amenities at higher health facilities compared to lower level facilities. It was also observed that the patients were more satisfied with the behavior of doctors and staff at lower health facilities compared to higher level facilities.
Ashish, Naveen; Biswas, Antarip; Das, Sumit; Nag, Saurav; Pratap, Rajiv
This paper describes a technology to connect patients to information in the experiences of other patients by using the power of structured big data. The approach, implemented in the Abzooba Smart Health Informatics Platform (SHIP),is to distill concepts of facts and expressions from conversations and discussions in health social media forums, and use those distilled concepts in connecting patients to experiences and insights that are highly relevant to them in particular. We envision our work...
Nombeko Mshunqane; Aimee V. Stewart; Allan D. Rothberg
Background: South African research indicates that the highest death rates between 2004 and 2005 were from diabetes mellitus. There is minimal research information on interactions between what patients know about their disease and what health professionals perceive that patients should know to control their disease well.Objectives: This study determined the knowledge that patients with type 2 diabetes have about the management of their disease, as well as the perceptions of the health care tea...
Dwinger, Sarah; Dirmaier, Jörg; Herbarth, Lutz; König, Hans-Helmut; Eckardt, Matthias; Kriston, Levente; Bermejo, Isaac; Härter, Martin
Background The rising prevalence of chronic conditions constitutes a major burden for patients and healthcare systems and is predicted to increase in the upcoming decades. Improving the self-management skills of patients is a strategy to steer against this burden. This could lead to better outcomes and lower healthcare costs. Health coaching is one method for enhancing the self-management of patients and can be delivered by phone. The effects of telephone-based health coaching are promising, ...
Awan, Masood Sarwar; Waqas, Muhammad; Aslam, Muhammad Amir; Abbas, Faisal
The intention of this study is to dig out the demographic, medical, economic and psychosocial factors that affect the health related quality of life of the hepatitis B and C patient in district Sargodha. 120 patients of hepatitis B and C virus were interviewed. WHOQOL-BREF questionnaire was followed for the construction of health-related quality of life (HRQOL) instrument. Age of the patient, disease severity, use of drug, pain, depression, financial hindrance and threat of death negatively a...
Xu, Wenxin; Li, Menglong; Yao, Jiwei
Background: Anxiety, depression, and other adverse psychological reactions are often observed in elderly hypertensive patients. Appropriate exercise is a safe form of adjuvant therapy without causing side effects among these patients, with consistent effects on patients’ mental health. In this study, a collective exercise intervention experiment was conducted to evaluate the mental health of elderly hypertensive patients and to verify the effect of the psychological intervention of collective...
Xu, Wenxin; Li, Menglong; Yao, Jiwei
Background: Anxiety, depression, and other adverse psychological reactions are often observed in elderly hypertensive patients. Appropriate exercise is a safe form of adjuvant therapy without causing side effects among these patients, with consistent effects on patients’ mental health. In this study, a collective exercise intervention experiment was conducted to evaluate the mental health of elderly hypertensive patients and to verify the effect of the psychological intervention of collective...
Rasouli-Ghahroudi, Amir Alireza; Khorsand, Afshin; Yaghobee, Siamak; Rokn, AmirReza; Jalali, Mohammad; Masudi, Sima; Rahimi, Hamed; Kabir, Ali
BACKGROUND The aim of this study was to investigate knowledge, attitude and practice (KAP) of cardiovascular disease (CVD) patients about their oral health status. METHODS In this cross-sectional study, we analyzed the data of 150 CVD patients that collected by a self-administered questionnaire consists of demographic characteristics and KAP. Oral health indicators calculated based on the results of oral examination by an expert dentist. RESULTS CVD patients had an overall moderate level of k...
McDougall, A.; McDonald, T.; Koduah, H; Round, J.; Clark, F.; Bourn, J
1 The Department of Health has a Public Service Agreement target to ensure that by the end of 2005 every hospital appointment in the National Health Service in England (the NHS) will be booked for the convenience of the patient, making it easier for patients and their General Practitioners (GPs) to choose the hospital and consultant that best meets their need. The Department aims to provide patients with the opportunity to choose between four to five healthcare provide...
Cox, S.; O'Donoghue, A. C.; McKenna, W. J.; STEPTOE, A
OBJECTIVE: To assess the health related quality of life and psychological wellbeing of patients with hypertrophic cardiomyopathy, to correlate these with symptoms, clinical, and psychosocial factors. DESIGN: Questionnaire distributed to 171 hypertrophic cardiomyopathy patients aged at least 14 years, selected at random from a dataset of 480 patients. Assessments included the Short Form 36 (SF-36) Health Survey, the Hospital Anxiety and Depression questionnaire, and measures of adjustment, wor...
Dongmin Shin; Dongil Shin; Dongkyoo Shin
For patients who have a senile mental disorder such as dementia, the quantity of exercise and amount of sunlight are an important clue for doses and treatment. Therefore, monitoring daily health information is necessary for patients’ safety and health. A portable and wearable sensor device and server configuration for monitoring data are needed to provide these services for patients. A watch-type device (smart watch) that patients wear and a server system are developed in this paper. The smar...
Millenium Challenge Corporation — The randomized rollout design that was developed for the Lesotho Health Centers was rendered infeasible due to infrastructure delays. Before pursuing an alternative...
Full Text Available Anjali Patwardhan,1 Charles H Spencer21Nationwide Children’s Hospital Columbus, 2Ohio State University, Columbus, OH, USAAbstract: Improving the quality of care in international health services was made a high priority in 1977. The World Health Assembly passed a resolution to greatly improve “Health for all” by the year 2000. Since 1977, the use of patient surveys for quality improvement has become a common practice in the health-care industry. The use of surveys reflects the concept that patient satisfaction is closely linked with that of organizational performance, which is in turn closely linked with organizational culture. This article is a review of the role of patient surveys as a quality-improvement tool in health care. The article explores the characteristics, types, merits, and pitfalls of various patient surveys, as well as the impact of their wide-ranging application in dissimilar scenarios to identify gaps in service provision. It is demonstrated that the conducting of patient surveys and using the results to improve the quality of care are two different processes. The value of patient surveys depends on the interplay between these two processes and several other factors that can influence the final outcome. The article also discusses the business aspect of the patient surveys in detail. Finally, the authors make future recommendations on how the patient survey tool can be best used to improve the quality of care in the health-care sector.Keywords: patient surveys, quality improvement, service gaps
Full Text Available Aim: Patient satisfaction is an important indicator to evaluate the quality of primary health care service. It is also significant to improve the quality of medical care, expectation from health staff, priority of patient needs, views and feedbacks about medical services in primary health care. Our objective in this study is to determine the patient satisfaction and the factors effecting this aspect in the evaluation of primary health care quality. Material and Method: This research was carried out in one Mother and Child Health and Family Planning Centre and nine Health Centers in January 2009 at Afyonkarahisar center. The questionnaire was performed to investigate the degree of satisfaction about health services, and socio-demographic characteristics of patients admitted to primary health care by face to face interview method. The data was evaluated by SPSS 15.00.Results: 1227 patients participating in the study, 809 women and 418 were male, married 878, 290 were single.Their education level was 408 graduated from primary school. At the same time, their job distributions were 596 housewives, 133 retired. When the patients had health problems, the most preferable institutione was health center, the choice of the reasons they were satisfied with the services in general, determined as to obtain quick results and confidence in solving problems.75% of the patients waiting time for admission and registration procedures were 0-5minutes. The admission reasons were mostly physical examination and prescription. Patients who are male, aged above 50 years and low educated had much higher satisfaction levels. Discussion: As a result, decreased satisfaction with higher education level, satisfaction increased with increasing age and a short waiting period for the application-registration and examination procedures were being influenced patient satisfaction.
Forss M; Batcheller G; Skrtic S; Johannsson G
Abstract Background The aim was to survey current practice in glucocorticoid replacement therapy and self-perceived health outcomes in patients with adrenal insufficiency. Methods Participants were recruited via patient organizations to respond anonymously to a web-based survey developed by clinical experts. Unique entries were set up for each patient organization enabling geographical localization of the entries. Results 1245 participants responded (primary adrenal insufficiency: 84%; second...
The overall aim was to study self-care, foot problems and self-perceived health in 150 consecutively invited Tanzanian diabetic patients and to compare them with gender- and age-matched Swedish diabetic patients (n=150) from a middle Sweden area. The main study was cross-sectional and took place at a diabetes clinic in Dar es Salaam. All patients answered questions about their self-care satisfaction, diabetes knowledge and skills, and educational needs. Foot examination also included question...
Nicolau Silveira Neto; João Paulo de Carli; Maria Salete Sandini Linden; Micheline Sandini Trentin; Soluete Oliveira da Silva; Luciele Raquel Luft
Objective: Considering that oral health, as well as general health are fundamental for maintaining the quality of life, the objective of this study was to investigate the oral health of the elderly population in the São José and Nossa Senhora da Luz Care Centers in Passo Fundo/ RS, Brazil. Methods: a clinical examination was performed in 107 elderly patients, to evaluate the oral health status as regards periodontal disease, edentulism, physiological alterations, and mucosa infection by the C...
Rademakers, J.; Nijman, J.; Brabers, A.E.M.; Jong, J.D. de; Hendriks, M.
Active provider choice by patients has become an important policy theme in western, countries over the last decades. However, not many patients and consumers exercise their rightto, choose. Both health literacy and patient activation are likely to have an impact on the choiceprocess.In,this article
Martijn, L.M.; Harmsen, M.; Gaal, S.; Mettes, D.G.; Dulmen, S.A. van; Wensing, M.
OBJECTIVE: The study aims to explore whether health care professionals' perceptions of patient safety in their practice were associated with the number of patient safety incidents identified in patient records. SETTING: Seventy primary care practices of general practice, general dental practice, mid
Woods, Susan S; Evans, Neil C; Frisbee, Kathleen L
Electronic health record content is created by clinicians and is driven largely by intermittent and brief encounters with patients. Collecting data directly from patients in the form of patient-generated data (PGD) provides an unprecedented opportunity to capture personal, contextual patient information that can supplement clinical data and enhance patients' self-care. The US Department of Veterans Affairs (VA) is striving to implement the enterprise-wide capability to collect and use PGD in order to partner with patients in their care, improve the patient healthcare experience, and promote shared decision making. Through knowledge gained from Veterans' and healthcare teams' perspectives, VA created a taxonomy and an evolving framework on which to design and develop applications that capture and help physicians utilize PGD. Ten recommendations for effectively collecting and integrating PGD into patient care are discussed, addressing health system culture, data value, architecture, policy, data standards, clinical workflow, data visualization, and analytics and population reach. PMID:26911810
Sérgio Bergmann Borges Vieira
Full Text Available This article presents a theoretical review of the doctor-patient relation in the context of health as a socio-cultural product of postmodernity. We searched the data bases Pub Med, Lilacs and the Cochrane Library in the Internet, using the key words doctor-patient relation, health, product and post-modernity. We also searched medical textbooks as well as reference works in the fields of philosophy, sociology and marketing. The doctor-patient relation was analyzed based on the concepts health and product. Thus, by considering health a product of the consumer society, one discussed the changes that occurred in medical care and in the relation between the health professional (doctor and the patient (client.
Bazemore, Andrew W; Cottrell, Erika K; Gold, Rachel; Hughes, Lauren S; Phillips, Robert L; Angier, Heather; Burdick, Timothy E; Carrozza, Mark A; DeVoe, Jennifer E
Social determinants of health significantly impact morbidity and mortality; however, physicians lack ready access to this information in patient care and population management. Just as traditional vital signs give providers a biometric assessment of any patient, "community vital signs" (Community VS) can provide an aggregated overview of the social and environmental factors impacting patient health. Knowing Community VS could inform clinical recommendations for individual patients, facilitate referrals to community services, and expand understanding of factors impacting treatment adherence and health outcomes. This information could also help care teams target disease prevention initiatives and other health improvement efforts for clinic panels and populations. Given the proliferation of big data, geospatial technologies, and democratization of data, the time has come to integrate Community VS into the electronic health record (EHR). Here, the authors describe (i) historical precedent for this concept, (ii) opportunities to expand upon these historical foundations, and (iii) a novel approach to EHR integration. PMID:26174867
Ruers Theo JM
Full Text Available Abstract Background Many studies have found discrepancies in valuations for health states between the general population (healthy people and people who actually experience illness (patients. Such differences may be explained by referring to various cognitive mechanisms. However, more likely most of these observed differences may be attributable to the methods used to measure these health states. We explored in an experimental setting whether such discrepancies in values for health states exist. It was hypothesized that the more the measurement strategy was incorporated in measurement theory, the more similar the responses of patients and healthy people would be. Methods A sample of the general population and two patient groups (cancer, rheumatoid arthritis were included. All three study groups judged the same 17 hypothetical EQ-5D health states, each state comprising the same five health domains. The patients did not know that apart from these 17 states their own health status was also included in the set of states they were assessing. Three different measurement strategies were applied: 1 ranking of the health states; 2 placing all the health states simultaneously on a visual analogue scale (VAS; 3 separately assessing the health states with the time trade-off (TTO technique. Regression analyses were performed to determine whether differences in the VAS and TTO can be ascribed to specific health domains. In addition, effect of being member of one of the two patient groups and the effect of the assessment of the patients' own health status was analyzed. Results Except for some moderate divergence, no differences were found between patients and healthy people for the ranking task or for the VAS. For the time trade-off technique, however, large differences were observed between patients and healthy people. The regression analyses for the effect of belonging to one of the patient groups and the effect of the value assigned to the patients' own
The National Health Service (NHS) has been the body of the health care system in the United Kingdom (UK) for over 60 years and has sought to provide the population with a high quality service free of user charges for most services. The information age has seen the NHS rapidly transformed from a socialist, centrally planned and publicly provided system to a more market based system orientated towards patients as consumers. The forces of globalization have provided patients in the UK with greater choice in their health care provision, with NHS treatment now offered from any public or approved private provider and the possibility of treatment anywhere in the European Economic Area (EEA) or possibly further. The financial crisis, a large government deficit and austerity public spending policies have imposed a tight budget constraint on the NHS at a time of increasing demand for health care and population pressure. Hence, further rationing of care could imply that patients are incentivised to seek private treatment outside the constraints of the NHS, where the possibility of much greater choice exists in an increasingly globally competitive health care market. This chapter examines the evidence on the response of patients to the possibilities of increased choice and mobility within the internal NHS and external overseas health care markets. It also considers the relationships between patient mobility, health care provision and health policy. Patients are more mobile and willing to travel further to obtain better care outcomes and value for money, but are exposed to greater risk. PMID:24864384
Full Text Available Abstract Background Cancer health disparities affecting low-income and minority patients are well documented. Root-causes are multifactorial, including diagnostic and treatment delays, social and financial barriers, and poor communication. Patient navigation and communication coaching (activation are potential interventions to address disparities in cancer treatment. The purpose of this clinical trial is to test the effectiveness of an intervention combining patient navigation and activation to improve cancer treatment. Methods/Design The Rochester Patient Navigation Research Program (PNRP is a National Cancer Institute-sponsored, patient-level randomized trial (RCT of patient navigation and activation, targeting newly-diagnosed breast and colorectal cancer patients in Rochester, NY. The goal of the program is to decrease cancer health disparities by addressing barriers to receipt of cancer care and promoting patient self-efficacy. The intervention uses trained, paraprofessional patient navigators recruited from the target community, and a detailed training and supervisory program. Recruited patients are randomly assigned to receive either usual care (except for baseline and follow-up questionnaires and interviews or intervention. The intervention patients receive tailored assistance from their patient navigators, including phone calls, in-person meetings, and behind-the-scenes coordination of care. A total of 344 patients have been recruited. Outcomes measured at three month intervals include timeliness of care, patient adherence, patient satisfaction, quality of life, self-efficacy, health literacy, and cancer knowledge. Discussion This unique intervention combining patient navigation and patient activation is designed to address the multifactorial problem of cancer health disparities. If successful, this study will affect the design and implementation of patient navigation programs. Trials Registration clinicaltrials.gov identifier NCT
Gildberg, Frederik Alkier; Bradley, Stephen K.; Paaske, Kristian J.;
Humor utilized in the practice of forensic mental health nursing might seem somehow inappropriate, given the serious circumstances surrounding most forensic mental health patients. However, some recent research has pointed to the use of humor as an important component in staff interactions with...... forensic mental health patients. This study reviews the existing international forensic mental health research literature on humor to investigate (a) what characterizes forensic mental health staff-patient use of humor and (b) what significance humor holds within the forensic mental health setting. The...... search was conducted in June 2013. Scopus, CINAHL, PubMed, and PsychINFO were searched using keywords relevant to the study. Articles were categorized using a literature matrix and analyzed using thematic analysis. Twelve research articles were reviewed and included in the analysis. Three themes were...
Schuklenk, Udo; Smalling, Ricardo
This paper discusses a number of critical ethical problems that arise in interactions between queer patients and health care professionals attending them. Using real-world examples, we discuss the very practical problems queer patients often face in the clinic. Health care professionals face conflicts in societies that criminalise same sex relationships. We also analyse the question of what ought to be done to confront health care professionals who propagate falsehoods about homosexuality in the public domain. These health care professionals are more often than not motivated by strong religious convictions that conflict with mainstream medical opinion on homosexuality. We argue that they ought to be held accountable for their conduct by their professional statutory bodies, given that they abuse their professional standing to propagate sectarian views not representative of their profession. Lastly, we propose that medical schools have special responsibilities in training future health care professionals that will enable them to respond professionally to queer patients seeking health care. PMID:23443248
Full Text Available BACKGROUND: Pay-for-performance for patients is a cost-effective means of improving health behaviours. This study examined the association between the pay time for performance for patients and CHS use by chronic patients. METHODS: A cross-sectional study was undertaken to estimate distribution characteristics of CHS use in 2011 and collect data of socio-demographic characteristics (sex, age, education level, occupation, disposable personal income in 2011, distance between home and community health agency, chronic disease number, and time of pay-for-performance for patients. Participants were 889 rural adults with hypertension or type II diabetes aged 35 and above. Standardized CHS use means chronic patients use CHS at least once per quarter. RESULTS: Patients who received incentives prior to services had 2.724 times greater odds of using standardized CHS than those who received incentives after services (95%CI, 1.986-3.736, P<0.001. For all subgroups (socio-demographic characteristics and chronic disease number, patients who received incentives prior to services were more likely to use standardized CHS than those receiving incentives after services. CONCLUSIONS: Pay time for performance for patients was associated with CHS use by chronic patients. Patients receiving incentive prior to services were more likely to use standardized CHS. And pay time should not be ignored when the policy on pay-for-performance for patients is designed.