What types of recommendations are we giving patients? A survey of clinical neuropsychologists.

OBJECTIVE: To identify types of recommendations that neuropsychologists most frequently give to patients, and determine which specific recommendations are most and least consistently given to patients across and within different diagnostic populations. METHOD: A total of 309 clinical neuropsychologists completed a survey evaluating the frequency with which they made particular types of recommendations (e.g. driving, employment and education, health and rehabilitation referrals) to patients with various disorders (e.g. traumatic brain injury, dementia). RESULTS: Recommendations in some categories were common across diagnoses (e.g. recommendations related to health). Neuropsychologists reported being more likely to give patients with dementia (relative to other clinical populations) recommendations related to educational resources, supervision and independence, and driving. Patients with a TBI diagnosis were more likely to be given recommendations related to employment and education, health and rehabilitation referrals, and mental health and substance use. Patients with a psychiatric diagnosis were more likely to be given recommendations related to mental health and substance use. Irrespective of diagnosis, neuropsychologists reported being most likely to give recommendations that could be implemented by the patient or caregiver without assistance from outside sources. Neuropsychologists varied in their use of recommendations to seek evaluations and treatment from health and rehabilitation referrals and in providing recommendations related to driving. CONCLUSIONS: Recommendations provided within diagnostic groups are consistent with the etiology and prognosis of those conditions. Recommendations for the use of compensatory strategies to address cognitive deficits and recommendations to improve health were endorsed by the vast majority of neuropsychologists across diagnoses.

Patient Perspectives on Opioids: Views of Inpatient Veterans with Chronic Pain.

OBJECTIVE: To elucidate perspectives on opioids and opioid use from hospitalized veterans with comorbid chronic pain using qualitative methods. DESIGN: This was an analysis of individual qualitative interviews. The semistructured interview guide was developed by a hospitalist with clinical expertise in pain treatment with guidance from a medical anthropologist. Interviews aimed to understand participants' experiences of chronic pain. SETTING: A Midwestern Veterans Health Administration inpatient hospital unit. SUBJECTS: Nineteen inpatient veterans with a history of chronic pain or antecedent opioid use. METHODS: Recently admitted veterans were screened for chronic pain diagnosis on admission and antecedent opioid use. Eligible veterans were approached to participate in an in-person interview during their hospitalization. RESULTS: The following themes were identified in relation to opioid use: other patients as the problem (by misusing opioids resulting in broad limits to opioid access), empathy for providers (perceived to be working under prescribing constraints), and opioids as a last resort. CONCLUSIONS: Although participants were not specifically questioned about opioid medications, discussion of opioids was prevalent in discussions of chronic pain. Findings suggest the potential utility of engaging hospitalized veterans in conversations about opioids and alternative pain management strategies.

Recommendations for Driving After Neuropsychological Assessment: A Survey of Neuropsychologists.

Objective: To determine which patient, provider and practice-related characteristics are associated with increased likelihood of driving-related recommendations following a neuropsychological evaluation. Method: A total of 309 clinical neuropsychologists completed a survey evaluating the frequency with which they made various driving-related recommendations (e.g., take an on-road driving test) to a variety of clinical populations. Information regarding patient characteristics (e.g., perceived likelihood of adhering to recommendations), provider-related characteristics (e.g., years in practice) and practice-related characteristics (e.g., region of North America) were also collected. Correlation coefficients and multiple linear regressions controlling for patient diagnoses were used to examine which characteristics predicted greater likelihood of driving recommendations broadly. Significant characteristics were then entered into regressions to examine independent contributions of each characteristic to the likelihood of each individual driving recommendation. Results: Neuropsychologists reported giving a range of driving recommendations to most clinical populations, with the exception of patients with psychiatric diagnoses. Several characteristics (e.g., patient impairment) were associated with greater likelihood of driving recommendations broadly. After controlling for diagnoses, three significant predictors emerged: higher frequency of individualized recommendations, greater caregiver presence, and greater number of recommendations given. All three characteristics generally predicted frequency of all individual driving recommendations. Conclusions: While patients' diagnoses may be indicative of whether they receive driving-related recommendations, certain patient and provider-related factors also uniquely contribute to the likelihood of driving-related recommendations after neuropsychological assessment.

Does a Simple Intervention Enhance Memory and Adherence for Neuropsychological Recommendations?

The variables that influence the extent to which patients and their families remember and follow neuropsychological recommendations after their appointments are unclear. There has been limited research on this topic. The current study was designed to address this knowledge gap. Patients (n = 79) and caregivers (n = 36) were randomized into 1 of 2 groups, letter or no-letter, to investigate whether providing a supplemental written reminder of the recommendations given (in addition to routine feedback procedures in our clinic) would improve memory for and adherence to recommendations. We found that recall of recommendations was better in the letter condition, although this effect was observed in the caregivers and not in the patients. Adherence to recommendations did not differ significantly between the letter and no-letter conditions. These findings show that a simple intervention can improve caregiver memory for recommendations. Future research could help determine how to translate improvements in memory into greater adherence.