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The purpose of the paper is to describe and analyze differences in patients' quality perceptions of private and public primary care centers in Sweden.

The article explores the differences in quality perceptions between patients of public and private primary care centers based on data from a large patient survey in Sweden. The survey covers seven dimensions, and in this paper the measure Overall impression was used for the comparison. With more than 80,000 valid responses, the survey covers all primary care centers in Sweden which allowed for a detailed analysis of differences in quality perceptions among patients from the different categories of owners.

The article contributes with a detailed description of different types of private owners: not-for-profit and for profit, as well as corporate groups and independent care centers. The results show a higher quality perception for independent centers compared to both public and corporate groups.

The small number of not-for-profit centers (21 out of 1,117 centers) does not allow for clear conclusions for this group. The results, however, indicate an even higher patient quality perception for not-for-profit centers. The study focus on describing differences in quality perceptions between the owner categories. Future research can contribute with explanations to why independent care centers receive higher patient satisfaction.

The results from the study have policy implications both in a Swedish as well as international perspective. The differentiation between different types of private owners made in this paper opens up for interesting discussions on privatization of healthcare and how it affects patient satisfaction.

The main contribution of the paper is the detailed comparison of different categories of private owners and the public owners.

The aim of this study is to explore and discuss key challenges associated with having stakeholders take part in co-designing a health care intervention to increase mobility in older medical patients admitted to two medical departments at two hospitals in Denmark.

The study used a qualitative design to investigate the challenges of co-designing an intervention in five workshops involving health professionals, patients and relatives. “Challenges” are understood as “situations of being faced with something that needs great mental or physical effort in order to be done successfully and therefore tests a person's ability” (Cambridge Dictionary). Thematic content analysis was conducted with a background in the analytical question: “What key challenges arise in the material in relation to the co-design process?”.

Two key challenges were identified: engagement and facilitation. These consisted of five sub-themes: recruiting patients and relatives, involving physicians, adjusting to a new researcher role, utilizing contextual knowledge and handling ethical dilemmas.

The population of patients and relatives participating in the workshops was small, which likely affected the co-design process.

Researchers who want to use co-design must be prepared for the extra time required and the need for skills concerning engagement, communication, facilitation, negotiation and resolution of conflict. Time is also required for ethical discussions and considerations concerning different types of knowledge creation.

Engaging stakeholders in co-design processes is increasingly encouraged. This study documents the key challenges in such processes and reports practical implications.

The purpose of this paper is to determine the factors associated with patient delay among tuberculosis patients in border hospitals, Chiang Rai province, Thailand.

A cross-sectional study was conducted in the four biggest border hospitals in Chiang Rai province, Thailand during May to July 2018 among 103 identified TB cases. Data were collected by a face-to-face interview with structured questionnaire on patients’ general characteristics, HIV status and patient delay status. Descriptive statistics were used to analyze the patients’ general characteristics, HIV and patient delay status. The association among variables and patient delay was analyzed by χ²-test. The variables with p-value<0.20 obtained in bivariate analysis were further analyzed by binary logistic regression and considered significant with p-value<0.05.

All patients enrolled, most were reported with patient delay (65.0 percent). Bivariate analysis demonstrated that level of education, nationality and HIV status were associated factors for patient delay. Among these factors, binary logistic regression revealed that HIV negative TB patients were increased 6.806-fold odds of being patient delay (OR = 6.806; 95% CI: 1.174–39.462), while non-Thai TB patients were also increased 2.824-fold odds of being patient delay (OR = 2.824; 95% CI: 1.041–7.660).

Patient delay among TB patients in Chiang Rai province was high. This study further supports the requirement on promoting of TB knowledge and awareness emphasized on non-Thai population and general public along the border areas of Chiang Rai province.

A broader challenge of co-creating digital solutions with patients addresses the question how to apply an open-access digital platform with trusted digital health information as a measure to transform the way patients access and understand health information. It further addresses use this for adherence to treatment, risk minimization and quality of life throughout the integrated patient journey. The aim of this paper is to demonstrate the early steps in towards progress to co-creating the digital solution.

To coordinate the co-creation process, the authors established a multiphased plan to deep-dive into user needs and behaviors across patient journeys, to identify nuances and highlight important patterns in stakeholder and end-user segment at various stages in the patient's journey.

A set of tools was designed to serve as a human-centered compass throughout the lifecycle of the project. Those tools include shared objects; personas, user journeys, a set of performance indicators with related requirements – all those tools being consistently refined in ongoing co-creation workshops with members of the cross-functional stakeholder groups.

In this study, a multidisciplinary, public-private partnership looked at integrated digital tool to improve access, understanding and adherence to treatment for diverse groups of patients across all stages of their health journeys in a number of countries including European Union (EU) and United States of America (USA). As a result of this work, the authors attempt to increase the possibility that the improved availability and understanding of health information from trusted sources translates to higher levels of adherence to treatment, safer use of medication (pharmacovigilance), better health outcomes and quality of life integrated in the patient's journey.

In order to create sustainable health systems, many countries are introducing ways to prioritise health services underpinned by a process of health technology assessment. While this approach requires technical judgements of clinical effectiveness and cost effectiveness, these are embedded in a wider set of social (societal) value judgements, including fairness, responsiveness to need, non-discrimination and obligations of accountability and transparency. Implementing controversial decisions faces legal, political and public challenge. To help generate acceptance for the need for health prioritisation and the resulting decisions, the purpose of this paper is to develop a novel way of encouraging key stakeholders, especially patients and the public, to become involved in the prioritisation process.

Through a multidisciplinary collaboration involving a series of international workshops, ethical and political theory (including accountability for reasonableness) have been applied to develop a practical way forward through the creation of a values framework. The authors have tested this framework in England and in New Zealand using a mixed-methods approach.

A social values framework that consists of content and process values has been developed and converted into an online decision-making audit tool.

The authors have developed an easy to use method to help stakeholders (including the public) to understand the need for prioritisation of health services and to encourage their involvement. It provides a pragmatic way of harmonising different perspectives aimed at maximising health experience.

All health care systems are facing increasing demands within finite resources. Although many countries are introducing ways to prioritise health services, the decisions often face legal, political, commercial and ethical challenge. The research will help health systems to respond to these challenges.

This study helps in increasing public involvement in complex health challenges.

No other groups have used this combination of approaches to address this issue.

Co-production has received increasing attention from managers and researchers in public services. In the health care sector, co-production has become a by-word for the meaningful engagement of patients yet there is still a lack of knowledge around what works when co-producing services. The paper sets out a set of pragmatic principles which may guide anyone embarking on co-producing health care services, and provides an illustration of a co-produced Young People’s Health Research Group in England. We conclude by outlining some learning points which are useful when establishing co-production projects.

In this paper, we contribute to the theorizing of patient involvement in organizational improvement by exploring concepts of “learning from patients” as mechanisms of organizational change. Using the concept of metaphor as a theoretical bridge, we analyse interview data (n = 20) from participants in patient engagement activities from two case study organizations in Ontario, Canada. Inspired by classic organizational scholars, we ask “what is the organization that it might learn from patients?”

Patient involvement activities are used as part of quality improvement efforts in healthcare organizations worldwide. One fundamental assumption underpinning this activity is the notion that organizations must “learn from patients” in order to enact positive organizational change. Despite this emphasis on learning, there is a paucity of research that theorizes learning or connects concepts of learning to organizational change within the domain of patient involvement.

Through our analysis, we interpret a range of metaphors of the organization, including organizations as (1) power and politics, (2) systems and (3) narratives. Through these metaphors, we display a range of possibilities for interpreting how organizations might learn from patients and associated implications for organizational change.

This analysis has implications for how the framing of the organization matters for concepts of learning in patient engagement activities and how misalignments might stymie engagement efforts. We argue that the concept and commitment to “learning from patients” would be enriched by further engagement with the sociology of knowledge and critical concepts from theories of organizational learning.

The impact of population ageing is significant, multifaceted and characterised by frailty and multi-morbidity. The COVID-19 pandemic has accelerated care pathways and policies promoting self-management and home-based care. One under-researched area is how patients and family caregivers manage the complexity of end-of-life therapeutic medicine regimens. In this position paper the authors bring attention to the significant strain that patients and family caregivers experience when navigating and negotiating this aspect of palliative and end-of-life care.

Focussing on self-care and organisation of medicines in the United Kingdom (UK) context, the paper examines, builds on and extends the debate by considering the underlying policy assumptions and unintended consequences for individual patients and family care givers as they assume greater palliative and end-of-life roles and responsibilities.

Policy makers and healthcare professionals often lack awareness of the significant burden and emotional work associated with managing and administering often potent high-risk medicines (i.e. opioids) in the domiciliary setting. The recent “revolution” in professional roles associated with the COVID-19 pandemic, including remote consultations and expanding community-based care, means there are opportunities for commissioners to consider offering greater support. The prospect of enhancing the community pharmacist's medicine optimisation role to further support the wider multi-disciplinary team is considered.

The paper takes a person-focused perspective and adopts a holistic view of medicine management. The authors argue for urgent review, reform and investment to enable and support terminally ill patients and family caregivers to more effectively manage medicines in the domiciliary setting. There are clear implications for pharmacists and these are discussed in the context of public awareness, inter-professional collaboration, organisational drivers, funding and regulation and remote care delivery.

In this viewpoint article, the authors consider the challenges in implementing restrictive policies, with a particular focus on how these policies are experienced, in practice, from alternative standpoints.

The authors draw on social science studies of decommissioning work to highlight how patient and official versions of value often vary, creating difficulties and distrust as restrictive policies are implemented. Patients and the public are well aware that financial calculations are somehow embedded in concepts of “evidence” and “value” but are usually unfamiliar with the social infrastructures that produce and utilise such concepts. The authors discuss with reference to a contemporary restrictive programme in England.

While policymakers and researchers frequently present restrictive policies as “win-win” scenarios (achieving both cost-savings for healthcare services and improved patient care), social science analyses highlight the potential for tensions and controversies between stakeholders. The authors recognise that cost containment is a necessary component of policymaking work but argue that policymakers and researchers should seek to map (and make visible) the socially organised reasoning, systems and processes that are involved in enacting restrictive policies. Although transparency may pose challenges, it is important for informed democratic engagement, allowing legitimate scrutiny of whose voices are being heard and interests served (the “winners” and “losers”).

The authors argue for social science analyses that explore overuse, value and restrictive practices from alternative (e.g. patient) standpoints. These can provide important insights to help identify priorities for intervention and support better communication.

Delivering patient-centered healthcare is now seen as one of the basic requirements of good quality care. In this research, the impact of the perceived quality of three experiential dimensions (Physical Environment, Empowerment and Dignity and Patient–Doctor Relationship) on patient's Experiential Satisfaction is assessed.

259 structured interviews were performed with patients in private and public hospitals across Italy. The research methodology is based in testing mediation and moderation effects of the selected variables.

The study shows that: perceived quality of Physical Environment has a positive impact on patient's Experiential Satisfaction; perceived quality of Empowerment and Dignity and perceived quality of Patient–Doctor Relationship mediate this relationship reinforcing the role of Physical Environment on Experiential Satisfaction; educational level is a moderator in the relationship between perceived quality of Patient–Doctor Relationship and overall Satisfaction: more educated patients pay more attention to relational items. Subjective Health Frailty is a moderator in all the tested relationships with Experiential Satisfaction: patients who perceive their health as frail are more reactive to the quality of the above-mentioned variables.

Physical Environment items are enablers of both Empowerment and Dignity and Patient–Doctor Relationship and these variables must be addressed all together in order to improve the value proposition provided to patients. Designing a hospital, beyond technical requirements that modern medicine demands and functional relationships between different medical departments, means dealing with issues like the anxiety of the patient, the stressful working environment for the hospital staff and the need to build a sustainable and healing building.