Promoting new users' online health consultation services usage behavior strategically.

Online consultation services have the potential to reduce the workload of healthcare staff, provide timely care to patients, and improve doctor-patient relationships. The COVID-19 pandemic has accelerated the development of these services and platforms, but it remains to be seen whether the general public will continue to use them after the pandemic is under control. This research proposes a framework to examine the factors contributing to UK adults' continued usage of online healthcare consultation services after COVID-19 restrictions have been lifted. A total of 430 new users completed surveys, and the results indicate that expectation confirmation, system quality, and information quality can positively impact users' self-efficacy toward using online consultation services. This, in turn, can influence their continued usage behavior. Furthermore, the results suggest that participants' perception of health risks can moderate the relationship between self-efficacy and continued usage behavior. The strategic implications of these findings are discussed.

Incidence and Risk Factors of Mental Illnesses Among Patients with Systemic Autoimmune Rheumatic Diseases: An 18-year population-based study.

OBJECTIVE: This study aimed to assess the incidence and risk factors surrounding mental illnesses in patients diagnosed with systemic autoimmune rheumatic diseases (SARDs). METHODS: This retrospective cohort study used nationwide, population-based claim data taken from Taiwan's National Health Insurance Research Database (NHIRD) to identify patients certified as having a catastrophic illness for Systemic lupus erythematosus (SLE), Rheumatoid arthritis (RA), Systemic sclerosis (SSc), Dermatomyositis (DM), Polymyositis (PM) or Sjogren's syndrome (SS) from the years 2002-2020. We furthermore calculated the incidence of mental illness in patients diagnosed with SARDs while exploring factors associated with the development of mental illness using multivariable Cox regression analysis shown as adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS: Among the 28 588 participants, the average age was 47.4 (SD 14.9) years, with most participants being female (76.4%). When compared with patients with rheumatoid arthritis, patients with SLE (HR: 1.20, 95% CI: 1.10-1.32), SS (HR: 1.29, 95% CI: 1.19-1.39), and DM (HR: 1.28, 95% CI: 1.04-1.32) showed a significantly increased risk of developing mental illness. Additionally, when compared with patients with rheumatoid arthritis, patients with SLE (HR: 1.32, 95% CI: 1.21-1.44), SSc (HR: 1.20, 95% CI: 1.02-1.41), SS (HR: 1.17, 95% CI: 1.08-1.26), DM (HR: 1.73, 95% CI: 1.44-2.07), and PM (HR: 1.64, 95% CI: 1.32-2.03) showed a significantly increased risk of antidepressant use. CONCLUSIONS: This population-based cohort study revealed that patients diagnosed with SLE, SS and DM had significantly higher risks of developing mental illness when compared with patients with RA.

Association between self-efficacy, spiritual well-being and the willingness to provide spiritual care among nursing staff in Taiwan: a cross-sectional study.

BACKGROUND: Spiritual care plays a significant role in holistic patient care, addressing not only physical ailments but also attending to patients' emotional and spiritual well-being. While the importance of spiritual care in nursing is widely recognized, there is often a gap in understanding nurses' willingness to provide such care. This cross-sectional study aimed to explore the association between self-efficacy, spiritual well-being, and willingness to provide spiritual care among nursing staff. METHODS: The study conducted a cross-sectional survey of full-time registered nurses at a hospital in Taiwan from January 2019 to December 2019. A sample comprising 168 nurses was selected for participation in the study through a random sampling method. In addition to collecting demographic variables, the assessment tools used in the study include the General Self-Efficacy Scale (GSES) for measuring self-efficacy, the Spiritual Index of Well-Being Chinese Version (SIWB-C) for evaluating spiritual well-being, and the Spiritual Care Needs Inventory (SCNI) to gauge willingness to provide spiritual care. RESULTS: Most participants in the study were female, accounting for 98.2% (n = 165). The mean age of all 168 nurses was 37.1 ± 9.3 years. Additionally, most participants held a Bachelor's degree (79.2%, n = 133) and possessed clinical experience was 10.5 ± 9.3 years. Through logistic regression analysis, it was found that regardless of whether participants have received sufficient spiritual care training, both GSES and SIWB-C remain influential factors in determining the provision of spiritual care. CONCLUSIONS: Collaboration between healthcare management and nursing staff is essential for fostering a healthcare environment that not only appreciates the physical and spiritual dimensions of patient care but also prioritizes the enhancement of nurses ' self-efficacy and well-being.

Developing an innovative national ACP-OSCE program in Taiwan: a mixed method study.

OBJECTIVES: To evaluate the process and the comprehensiveness of advance care planning (ACP), we designed a national ACP-OSCE (Objective Structured Clinical Examination) program. METHODS: The program was designed as a 40-minute OSCE test. Participants were categorized as different ACP team members to illustrate realistic scenarios. Preceptors were asked to observe ACP professionals' actions, responses, and communication skills during ACP with standardized patients (SP) through a one-way mirror. Participants' communication skills, medical expertise, legal knowledge, empathetic response and problem-solving skills of ACP were also self-evaluated before and after OSCE. Thematic analysis was used for qualitative analysis. RESULTS: In Nov 2019, a total of 18 ACP teams with 38 ACP professionals completed the ACP-OSCE program, including 15 physicians, 15 nurses, 5 social workers, and 3 psychologists. After the ACP-OSCE program, the average score of communication skills, medical expertise, legal knowledge, empathetic response, ACP problem-solving all increased. Nurses felt improved in medical expertise, legal knowledge, and problem-solving skills, psychologists and social workers felt improved in legal knowledge, while physicians felt no improved in all domain, statistically. Thematic analysis showed professional skills, doctoral-patient communication, benefit and difficulties of ACP were the topics which participants care about. Meanwhile, most participants agreed that ACP-OSCE program is an appropriate educational tool. CONCLUSION: This is the first national ACP-OSCE program in Asia. We believe that this ACP-OSCE program could be applied in other countries to improve the ACP process and quality.

Palliative Care for Adult Patients Undergoing Hemodialysis in Asia: Challenges and Opportunities.

This article underscores the importance of integrating comprehensive palliative care for noncancer patients who are undergoing hemodialysis, with an emphasis on the aging populations in Asian nations such as Taiwan, Japan, the Republic of Korea, and China. As the global demographic landscape shifts towards an aging society and healthcare continues to advance, a marked increase has been observed in patients undergoing hemodialysis who require palliative care. This necessitates an immediate paradigm shift to incorporate this care, addressing the intricate physical, psychosocial, and spiritual challenges faced by these individuals and their families. Numerous challenges impede the provision of effective palliative care, including difficulties in prognosis, delayed referrals, cultural misconceptions, lack of clinician confidence, and insufficient collaboration among healthcare professionals. The article proposes potential solutions, such as targeted training for clinicians, the use of telemedicine to facilitate shared decision-making, and the introduction of time-limited trials for dialysis to overcome these obstacles. The integration of palliative care into routine renal treatment and the promotion of transparent communication among healthcare professionals represent key strategies to enhance the quality of life and end-of-life care for people on hemodialysis. By embracing innovative strategies and fostering collaboration, healthcare providers can deliver more patient-centered, holistic care that meets the complex needs of seriously ill patients within an aging population undergoing hemodialysis.

Trend analysis of quality indicators in palliative home care among terminally ill cancer and non-cancer patients in Taiwan: a 6-year observational study.

PURPOSE: Palliative home care services (PHCS) have been emerging for years. However, limited data exist regarding quality indicators for pain control, unplanned hospital readmissions, and household deaths among terminal cancer and non-cancer patients receiving PHCS. METHODS: We conducted a retrospective collection and recording of data from 1242 terminally ill cancer and non-cancer patients receiving PHCS. The data were obtained from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH) for the period from 2016 to 2021. T test and chi-square test were applied for characteristics and the quality indicators among cancer and non-cancer groups. Chi-square test was used for trend analysis of the number of patients receiving PHCS and the quality indicators among cancer and non-cancer groups throughout the study period. RESULTS: A total of 1242 terminally ill cancer and non-cancer patients who had received PHCS were documented by TCVGH from the years 2016 to 2021, including 221 non-cancer patients and 1021 cancer patients having an average age of 70. The number of terminally ill cancer and non-cancer patients receiving PHCS has increased annually since 2016. Another finding was that age was a statistically significant factor impacting quality indicators. On the other hand, compared to non-cancer patients, cancer patients had a higher likelihood of receiving treatment with analgesics when needed. Their odds of needing analgesics more than three times within 4 days after PHCS enrollment were significantly elevated [OR 4.188, 95% CI (1.002, 17.51)]. CONCLUSION: The results of this 6-year observational study indicate a substantial increase in the number of terminal cancer and non-cancer patients receiving PHCS over the past decade. Furthermore, aging plays an important role in life quality of terminal cancer and non-cancer patients.

Effects of cigarette smoking and secondhand smoke exposure on physical frailty development among community-dwelling older adults in Japan: Evidence from a 10-year population-based cohort study.

AIM: This study explored longitudinally the relationship between smoking and secondhand smoke and the incidence of physical frailty in community-dwelling Japanese older people. METHODS: Data collected from the National Institute for Longevity Sciences-Longitudinal Study of Aging database from 2002 to 2012 (third to seventh wave) among older adults aged ≥65 years were analyzed. Participants with physical frailty at baseline, as determined by the Cardiovascular Health Study criteria, missing data or who failed to attend follow ups were excluded. Data on current cigarette smoking and secondhand smoke exposure were collected from the third wave results. The generalized estimating equation model was used to examine the longitudinal relationships between smoking, secondhand smoke and subsequent frailty. RESULTS: The final analysis included 540 participants with a mean age of 71.4 years (standard deviation 4.6). The generalized estimating equation analysis showed that, compared with non-smokers, smokers were at significant risk of physical frailty (odds ratio [OR] 2.39, 95% confidence interval [CI] 1.21-4.74) after adjustment for multiple covariates; especially men (OR 3.75, 95% CI 1.76-8.00) and older adults aged ≥75 years (OR 4.12, 95% CI 1.43-11.87). Participants exposed to both smoking and secondhand smoke had a higher risk of physical frailty (OR 3.47, 95% CI 1.56-7.73) than non-smokers without secondhand smoke exposure. Smokers exposed to secondhand smoke were associated with more risk of physical frailty (OR 9.03, 95% CI 2.42-33.77) compared with smokers without secondhand smoke exposure. CONCLUSIONS: Smoking, especially when combined with secondhand smoke exposure, is associated with future physical frailty among older adults. Geriatr Gerontol Int 2024; 24: 142-149.

Association of a lesser number of teeth with more risk of developing depressive symptoms among middle-aged and older adults in Japan: A 20-year population-based cohort study.

OBJECTIVES: This 20-year prospective cohort study aimed to longitudinally explore the relationship between the number of teeth and the incidence of depressive symptoms among community-dwelling middle-aged and older adults. METHODS: Data were collected from the National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA) database from 2002 to 2022 (3rd-9th waves). Data of adults aged ≥40 years were analyzed and those who had depressive symptoms at baseline (3rd wave), had missing data, or did not participate in follow-up, were excluded. We collected data on the number of teeth at baseline. Depressive symptoms were defined as a score of ≥16 on the Center for Epidemiologic Studies Depression Scale. The generalized estimating equation (GEE) model was used to examine the longitudinal relationships between the number of teeth at baseline and the subsequent incidence of depressive symptoms. RESULTS: The final analysis included 1668 participants, with a mean (standard deviation) age of 58.8 (11.1) years and a mean follow-up time of 12.9 years. After GEE analysis with adjustment for multiple covariates, compared to participants with ≥20 teeth, participants with 10-19 teeth and < 10 teeth at baseline were associated with a higher risk of depressive symptoms. The subgroup analysis showed that the effect was stronger in men than in women. CONCLUSIONS: Among middle-aged and older community dwellers, particularly men, a small number of teeth after the age of 40 was associated with the future incidence of depressive symptoms.

International Variations in Dementia and Alzheimer Disease Diagnosis and Certification Habits and Their Associations With Dementia and Alzheimer Disease Mortality: A Cross-Sectional Study of 38 Countries.

OBJECTIVE: To examine international variations in national diagnosis and certification habits prefer recording dementia (D) versus Alzhiemer disease (AD) as the underlying cause of death (UCOD) and their associations with mortality rates of dementia and AD. METHODS: We calculated proportions of D/D+AD and AD/D+AD deaths as proxies of national diagnosis and certification habits. Pearson correlation coefficients (r) were estimated to assess the associations of proportions with the mortality rates of dementia or AD among adults aged 75 to 84 years across 38 countries. RESULTS: The countries with a high preference for recording dementia as the UCOD were Taiwan and Latvia with proportion of D/D+AD deaths of 92% and 88%, respectively, and those with a high preference for recording AD as the UCOD were Slovenia, Turkey, and Poland with proportion of AD/D+AD deaths of 100%, 99%, and 89%, respectively. The r values for the proportions and mortality rate for dementia and AD were 0.67 (95% CI: 0.44-0.81) and 0.46 (95% CI: 0.16-0.68), respectively. CONCLUSION: We identified a small number of countries with obvious natonal diagnosis and certification habits preferring dementia or AD and had moderate effects on international variations in the mortality rates of dementia and AD.

A model for predicting physical function upon discharge of hospitalized older adults in Taiwan-a machine learning approach based on both electronic health records and comprehensive geriatric assessment.

Background: Predicting physical function upon discharge among hospitalized older adults is important. This study has aimed to develop a prediction model of physical function upon discharge through use of a machine learning algorithm using electronic health records (EHRs) and comprehensive geriatrics assessments (CGAs) among hospitalized older adults in Taiwan. Methods: Data was retrieved from the clinical database of a tertiary medical center in central Taiwan. Older adults admitted to the acute geriatric unit during the period from January 2012 to December 2018 were included for analysis, while those with missing data were excluded. From data of the EHRs and CGAs, a total of 52 clinical features were input for model building. We used 3 different machine learning algorithms, XGBoost, random forest and logistic regression. Results: In total, 1,755 older adults were included in final analysis, with a mean age of 80.68 years. For linear models on physical function upon discharge, the accuracy of prediction was 87% for XGBoost, 85% for random forest, and 32% for logistic regression. For classification models on physical function upon discharge, the accuracy for random forest, logistic regression and XGBoost were 94, 92 and 92%, respectively. The auROC reached 98% for XGBoost and random forest, while logistic regression had an auROC of 97%. The top 3 features of importance were activity of daily living (ADL) at baseline, ADL during admission, and mini nutritional status (MNA) during admission. Conclusion: The results showed that physical function upon discharge among hospitalized older adults can be predicted accurately during admission through use of a machine learning model with data taken from EHRs and CGAs.

Additive effect of frailty with distinct multimorbidity patterns on mortality amongst middle-aged and older adults in Taiwan: A 16-year population-based study.

AIM: This study aimed to explore the association between multimorbidity patterns with/without frailty and future mortality among Taiwanese middle-aged and older adults through a population-based cohort study design. METHODS: Data were collected from the Taiwan Longitudinal Study on Aging. The data were obtained from Wave 3, with the multimorbidity patterns in the years of 1996 being analyzed through latent class analysis. Frailty was defined using the modified Fried criteria. The association between each disease group with/without frailty and mortality was examined using logistic regression, with the reference group as the Relatively healthy group without frailty. Survival analysis was performed using Cox regression, and the follow-up period of mortality was from 1 January 1996 to 31 December 2012. RESULTS: A total of 4748 middle-aged and older adults with an average age of 66.3 years (SD: 9.07 years) were included. Four disease patterns were identified in 1996, namely the Cardiometabolic (21.0%), Arthritis-cataract (11.9%), Relatively healthy (61.6%), and Multimorbidity (5.5%) groups. After adjusting for all covariates, the Relatively healthy group with frailty showed the highest risk for mortality (odds ratio: 3.66, 95% confidence interval [95% CI]: 2.24-5.95), followed by the Cardiometabolic group with frailty (odds ratio: 3.58, 95% CI: 1.96-6.54), Multimorbidity group with frailty (odds ratio: 2.28, 95% CI: 1.17-4.44), Multimorbidity group without frailty (odds ratio: 1.44, 95% CI: 1.01-2.04), and the Cardiometabolic group without frailty (odds ratio: 1.24, 95% CI: 1.04-1.49). CONCLUSIONS: Frailty plays an important role in mortality among middle-aged and older adults with distinct multimorbidity patterns. Middle-aged and older adults with a relatively healthy multimorbidity pattern or a cardiometabolic multimorbidity pattern with frailty encountered dismal outcomes. Geriatr Gerontol Int 2023; 23: 684-691.

Effects of different palliative care models on decedents with kidney failure receiving maintenance dialysis: a nationwide population-based retrospective observational study in Taiwan.

OBJECTIVES: Patients with kidney failure receiving maintenance dialysis are a particularly important population and carry a heavy disease burden. However, evidence related to palliative care for patients with kidney failure receiving maintenance dialysis remains scarce, especially in regard to palliative care consultation services and palliative home care. This study aimed to evaluate the effects of different palliative care models on aggressive treatment among patients with kidney failure receiving maintenance dialysis during the end of life. DESIGN: A population-based retrospective observational study. SETTING: This study used a population database maintained by Taiwan's Ministry of Health and Welfare in combination with Taiwan's National Health Research Insurance Database. PARTICIPANTS: We enrolled all decedents who were patients with kidney failure receiving maintenance dialysis from the period 1 January 2017 to 31 December 2017 in Taiwan. MAIN EXPOSURE MEASURE: Hospice care during the 1-year period before death. MAIN OUTCOME MEASURES: Eight aggressive treatments within 30 days before death, more than one emergency department visit, more than one admission, a longer than 14-day admission, admission to an intensive care unit, death in hospital, endotracheal tube use, ventilator use and need for cardiopulmonary resuscitation. RESULTS: A total of 10 083 patients were enrolled, including 1786 (17.7%) patients with kidney failure who received palliative care 1 year before death. Compared with patients without palliative care, patients with palliative care had significantly less aggressive treatments within 30 days before death (Estimates: -0.09, CI: -0.10 to -0.08). Patients with inpatient palliative care, palliative home care or a mixed model experienced significantly lower treatment aggressiveness within 30 days before death. CONCLUSIONS: Palliative care, particularly use of a mixed care model, inpatient palliative care and palliative home care in patients with kidney failure receiving dialysis, could all significantly reduce the aggressiveness of treatment within 30 days before death.