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Patient-centric exchanges, a major type of Health Information Exchange (HIE), empower patients to aggregate and manage their health information. This exchange model helps patients access, modify and share their medical information with multiple healthcare organizations. Although existing studies examine patient engagement, more research is required to investigate patients' attitudes and willingness to play an active role in patient-centered information exchange. The study's main objective is to develop a model based on the belief-attitude-intention paradigm to empirically examine the effects of patients' attitudes toward engagement in care on their willingness to participate in patient-centric HIE.

The authors conducted an online survey study to identify the antecedents and consequences of patients' attitudes toward engagement in care. To empirically test the research model, the authors collected data from a national sample (n = 357) of individuals in the United States. The data were analyzed using structural equation modeling (SEM).

The proposed model categorizes the antecedents to patients' attitudes toward engagement in patient-related and healthcare system factors. The results show that patient-related factors (perceived health literacy and perceived coping ability) and health system factors (perceived experience with the healthcare organization and perceived patient-provider interaction) significantly shape patient attitude toward care management engagement. The results indicate that patients' attitudes toward engaging in their healthcare significantly contribute to their willingness to participate in medical information sharing through patient-centric HIE initiatives. Moreover, the authors’ findings also demonstrate that the link between patient engagement and willingness to participate in HIE is stronger for individuals who perceive lower levels of privacy and security concerns.

The authors validate the proposed model explaining patients' perceptions about their characteristics and the healthcare system significantly influence their attitude toward engaging in their care. This study also suggests that patients' favorable attitude toward engagement can bring patient-centric HIE efforts onto a path to success. The authors’ research attempts to shed light on the importance of patients' roles in adopting patient-centric HIE initiatives. Theoretical and practical contributions of this study are noticeable since they could result in a deeper understanding of the concept of patient engagement and how it may affect healthcare services in an evolving digital world. The authors’ findings can help healthcare organizations provide public citizen-centric services by introducing user-oriented approaches in healthcare delivery systems.

The purpose of this paper is to posit that it is possible to identify contributing factors for “never events,” preventable adverse events in the healthcare setting, and to develop “best practices” to prevent them.

This paper focuses on three specific never events: patient falls, pressure ulcers, and hospital acquired pneumonia. A model is suggested to identify “gold standard best practice” protocols to be used to prevent these events. A literature review identifies two categories of factors: uncontrollable patient‐related factors and controllable environmental related factors. The methodology is to use the Institute for Healthcare Improvement (IHI) Breakthrough Series Collaborative Model to develop best practice protocols for controllable environmental factors.

Controllable environmental variables may be positively impacted by using Theory of Inventive Problem Solving (TRIZ), Value Stream Mapping, Kanban, 5S technique, Reduction of Complexity, Total Production Maintenance, Poke‐Yoke, and Quick Change Overs. Controllable environmental variables may then be positively impacted by these methodologies and tools.

The tools and methods indicated have been used individually in the healthcare sector, but this approach has never been used in an integrated manner. The concept is to work with patient safety organizations in order to reduce never events in healthcare; events that, to date, have significantly increased the costs of healthcare and reduced the quality of processes and outcomes in healthcare.

This article aims to explore the factors influencing patients' distrust toward doctors in online health community.

This study leveraged the distrust construct model and socio-technical systems theory to establish a research model. The authors used the survey method to validate the research model by developing and distributing questionnaires to online health community users. 518 valid responses were collected.

The data analysis results showed that patients' distrusting beliefs were significantly related to their distrust toward doctors in online health communities. Meanwhile, social factors included perceived egoism and lack of expertise; whereas technical factors included no structural assurance, and lack of third-party recognition.

This study not only provides a solid and comprehensive theoretical understanding of patient distrust toward doctors in online health communities but also could serve as the basis to relieve the distrust between patients and doctors in online health communities, or even in the offline environment.

Multiple sclerosis (MS) is a chronic autoimmune neurological disease. Disease-modifying therapies (DMTs) are mainstay lifelong treatment with no immediate benefits observed. Adherence to treatment is necessary, however, non-adherence is common problem in MS patients. This paper aims to evaluate patient-related factors and satisfactions affecting medication adherence in Saudi MS patients and their rights to discontinue them against medical advice.

In total, 409 patients diagnosed with MS, using self-administered DMT (oral and injectable), were randomly enrolled in a cross-sectional study. Electronic questionnaire was used in data collection.

Most participants (71.1%) did not know about their MS type. Average age of participants when diagnosed with MS was 27.9 ± 8 years (range 7–69), mean disease duration was 8.1 ± 6.6. Most patients received injectable therapy 363 (88%). Overall adherence in our sample was 67%. Age of participants and duration of disease had no impact on treatment adherence. No significant differences found between genders, educational level, marital status, and smoking in relation to treatment adherence. Route of administration did not reach statistical significance despite a higher percentage of adherence reported in patients on oral DMT [33% (n = 15)] versus injectable therapy [29% (n = 104)]. Conversely, there was significant difference between adherent and non-adherent patients according to anxiety (p = 0.002) and family history of MS (p = 0.011).

The results revealed that the age of the participants and the duration of the disease had no impact on adherence to treatment.

The objective of this research is to synthesize evidence on the relationship between context, strategies and performance in the context of federally qualified health centers (FQHCs), a core safety net health services provider in the United States. The research also identifies prior approaches to measure contextual factors, FQHC strategy and performance. Gaps in the research are identified, and directions for future research are provided.

A systematic review of peer-reviewed journal articles published between the years 1997 and 2017 was conducted using a bibliographic search of PubMed, Business Source Premier and ABI/Inform databases.

28 studies were selected for the analysis. Results supported associations among contextual factors (organizational and environmental) and FQHC strategy and FQHC performance. The research also indicates that previous research was primarily emphasized on clinical performance with less focus on other types of FQHC performance. In addition, there exists a wide variability in terms of measuring context, FQHC strategy and performance.

Operating in resource-scarce and highly constraining environments, FQHCs have demonstrated the ability to stay innovative and competent as serving often unhealthier and costlier patient populations. To date, there has been no study that reviewed the relationships between context, FQHC strategy and FQHC performance. In addition, there is an absence of consensus on how context, FQHC strategy and FQHC performance are measured. This study is the first that examined context–strategy–performance relationships in the context of FQHCs.

Inpatient violence can have a major impact in terms of traumatic experiences for victims and witnesses, an unsafe treatment climate, and high-financial costs. Therefore, the purpose of this paper is to gain more insight into patterns of violent behavior, so that adequate preventive measures can be taken.

Data on inpatient violence in a Dutch forensic psychiatric hospital between 2008 and 2014 were extracted from hospital files on 503 patients.

More than half of all the patients (n=276, 54.9 percent) displayed verbal aggression on at least one occasion, whereas 27.2 percent of all patients (n=137) exhibited one or more incidents of physical violence. Female patients were responsible for more physically violent episodes than male patients. Patients admitted with a civil court order exhibited more violent behavior than patients with a criminal court order. Violent patients with a civil commitment had a significantly longer length of stay than non-violent patients with a civil commitment. More violence was found to take place on the earlier days of the week.

This study points at important differences between groups of forensic inpatients in frequency and type of inpatient violent behavior and in temporal factors. Interventions aimed at reducing the number of violent incidents should take these differences into account. Further research is necessary to gain more insight into the background of inpatient violence.

This paper seeks to show that there is inappropriate utilization of resources in hospitals in all three health care sectors (whether Ministry of Health, military or private). Such misuses can be tracked down by understanding the factors associated with such utilization.

The results were based on the assessment of some of the health staff and it could be argued that the rate of inappropriate utilization of hospital resources would have been different if it had been based on the patients' own assessments.

The results of this study show that regardless of the hospital type (or ownership), a substantial percentage of respondents perceive that hospital resources are inappropriately utilized. In fact, more than half of respondents in the three health care sectors indicate that the utilization of hospital resources is inappropriate. These results are inline with previous research which reported that the patient or the patient's family can contribute to unnecessary utilization by pressuring the physician to admit or by delaying discharge. In addition, although not examined in this study, patient characteristics such as lack of family support, age and lack of a health post‐discharge influence inappropriate hospital utilization.

If overutilization or underutilization continues in this vein, it will markedly increase the burden on these hospitals and adversely affect the delivery of health services to the Saudi population.

While several studies in different countries have described the problem of inappropriate utilization of hospital facilities, no previous studies in the Kingdom of Saudi Arabia appear to have discussed this issue other than the present study.

The purpose of this paper is to evaluate the contribution of medical information systems (IS) to efficient use of information when diagnosing chest pain complaints with suspected acute myocardial infarction (AMI) as regards ordering of tests and accuracy of diagnosis.

In total, 102 physicians were asked to diagnose three cases of chest pain in patients consulting an emergency department (ED) in a simulation study. Half of the participants had access to a medical IS with complete patient information and the other half of the physicians did not.

It was found that participants who viewed the medical IS ordered fewer clinical examinations. Participants who viewed the medical histories made a more accurate main differential diagnosis (DD) of AMI. Physicians with access to the medical history reported significantly higher levels of confidence in their decisions, regardless of seniority.

The findings suggest that IS leads to better utilization of medical services, greater efficiency and lower costs and thus has implications for other healthcare sectors.

In bereavement, memories of the loss, especially traumatic ones, can be distressful and complicate the grieving process. Although some conventional therapies have proven beneficial in lessening complicated bereavement, African indigenous methods used for the same purpose have not been well-documented. This study explored Northern Sotho traditional healers’ lived experiences regarding the medicinal benefits of Bolebatša when used in mental health-care.

Using interpretative phenomenological analysis, this study explored traditional healers’ (n = 19; 5 = males; females = 14; mean age = 65 years, SD: 11.6) experiences and their insights regarding the management of traumatic memories in bereavement. Participating healers were sampled using convenience and snowball strategies while data was collected using face-to-face dialogues, observations and a digital camera. Qualitatively derived data was transcribed and translated from the local language to English before it was analysed phenomenologically.

Data analysis resulted in four major themes: characterisation of Bolebatša as a herb used to manage mental and spiritual conditions; descriptions of the herb’s administration, dosage and related user health risk; perceived therapeutic benefits of the herb; and observed link between herbal medicine and African spirituality. The study findings suggest that the Bolebatša herb, derived from the tree scientifically called Lannea schweinfurthii is primarily used to induce forgetfulness of bereavement and trauma-related memories to enhance coping.

Whilst this study illustrates the perceived healing benefits of Bolebatša in mental health care, it is noted that the findings may not necessarily be extrapolated to other contexts. Therefore, more studies are needed with the participation of traditional healers from different ethnic backgrounds to lend support to the present findings. Data from service users’ experience of traditional healing in conjunction with traditional healers would have further benefited this study.

The findings are important for mental health professions as they open avenues for other forms of treatment for mental conditions that also need attention. Equally, there is a need for western trained mental health-care practitioners and researchers to study indigenous knowledge systems of healing for reverse knowledge transfer purposes.

The findings also call on governments, and in this context, the South African government, to recognise, support and empower traditional healers as important role players in primary mental health care. Collaboration between western mental health practitioners and traditional healers could indeed be one important strategy towards the relief of the overwhelmed mental health-care systems in low-and-middle-income countries such as is the case in South Africa.

The findings open new avenues to scientific explorations of the significance of traditional medicines in bereavement care and coping. More importantly, on the Bolebatša herb’s anti-depressive and memory altering effects in mental health care.

Higher caseloads are associated with better outcomes for many conditions treated in secondary and tertiary care settings, including colorectal cancer (CRC). There is little known whether such volume-outcome relationship exist in primary care settings. The purpose of this paper is to examine general practitioner (GP) CRC-specific caseload for possible associations with referral pathways, disease stage and CRC patients’ overall survival.

The paper retrospectively analyses a prospectively maintained CRC database for 2009-2014 in a single district hospital providing bowel cancer screening and tertiary rectal cancer services.

Of 1,145 CRC patients, 937 (81.8 per cent) were diagnosed as symptomatic cancers. In total, 210 GPs from 44 practices were stratified according to their CRC caseload over the study period into low volume (LV, 1-4); medium volume (MV, 5-7); and high volume (HV, 8-21 cases). Emergency presentation (LV: 49/287 (17.1 per cent); MV: 75/264 (28.4 per cent); HV: 105/386 (27.2 per cent); p=0.007) and advanced disease at presentation (LV: 84/287 (29.3 per cent); MV: 94/264 (35.6 per cent); HV: 144/386 (37.3 per cent); p=0.034) was more common amongst HV GPs. Three-year mortality risk was significantly higher for HV GPs (MV: (hazard ratio) HR 1.185 (confidence interval=0.897-1.566), p=0.231, and HV: HR 1.366 (CI=1.061-1.759), p=0.016), but adjustment for emergency presentation and advanced disease largely accounted for this difference. There was some evidence that HV GPs used elective cancer pathways less frequently (LV: 166/287 (57.8 per cent); MV: 130/264 (49.2 per cent); HV: 182/386 (47.2 per cent); p=0.007) and more selectively (CRC/referrals: LV: 166/2,743 (6.1 per cent); MV: 130/2,321 (5.6 per cent); HV: 182/2,508 (7.3 per cent); p=0.048).

Higher GP CRC caseload in primary care may be associated with advanced disease and poorer survival; more work is required to determine the reasons and to develop targeted intervention at local level to improve elective referral rates.