Exploring the perspectives of patients about their care experience: identifying what patients perceive are important qualities in cancer care.

INTRODUCTION: Delivering person-centered care begins with understanding perspectives of individuals who are recipients of care about their experiences and what constitutes a "positive" experience. METHODS: This project explored views of individuals with cancer regarding their care experiences and identified aspects of care patients thought were important through a qualitative analysis of data from the Ambulatory Oncology Patient Satisfaction Survey (AOPSS). Permission was obtained from seven Canadian provinces to access de-identified written comments to a final open-ended question on the survey: Is there anything else you would like to tell us about your cancer care experience? The descriptive qualitative analysis was guided by two questions: (1) what is the nature of the written comments and (2) what are key ideas expressed about care experiences? Key ideas were collated across provinces to identify significant themes within the national sample. RESULTS: The sample included comments from 6232 individuals. A total of 42.5% comments were positive, 29.7% were negative, and 19.8% were mixed. Four broad themes were identified from the comments: (1) characteristics of a "positive" experience, (2) personal care, (3) interaction with health care providers, and (4) service delivery. Respondents cited being treated as a person with respect and dignity, clear communication, access to relevant and timely information, and care that takes their needs into account as important aspects. Communication, consistency, and ongoing interactions with staff were highlighted as essential elements of a positive experience, yet areas where improvements in care are necessary. CONCLUSION: Patients reported a range of aspects that contribute to positive and negative care experiences which can be used to guide quality improvement initiatives in cancer centers. Results underscore the importance of having data collection systems in place to ensure agencies and providers have timely feedback about patients' experiences and concerns in order to provide responsive and individualized care.

Diabetic retinopathy screening with pharmacy-based teleophthalmology in a semiurban setting: a cost-effectiveness analysis.

BACKGROUND: Diabetic eye complications are the leading cause of visual loss among working-aged people. Pharmacy-based teleophthalmology has emerged as a possible alternative to in-person examination that may facilitate compliance with evidence-based recommendations and reduce barriers to specialized eye care. The objective of this study was to estimate the cost-effectiveness of mobile teleophthalmology screening compared with in-person examination (primary care) for the diabetic population residing in semiurban areas of southwestern Ontario. METHODS: A decision tree was constructed to compare in-person examination (comparator program) versus pharmacy-based teleophthalmology (intervention program). The economic model was designed to identify patients with more than minimal diabetic retinopathy, manifested by at least 1 microaneurysm at examination (modified Airlie House classification grade of ≥ 20). Cost-effectiveness was assessed as cost per case detected (true-positive result) and cost per case correctly diagnosed (including true-positive and true-negative results). RESULTS: The cost per case detected was $510 with in-person examination and $478 with teleophthalmology, and the cost per case correctly diagnosed was $107 and $102 respectively. The incremental cost-effectiveness ratio was $314 per additional case detected and $73 per additional case correctly diagnosed. Use of pharmacologic dilation and health care specialists' fees were the most important cost drivers. INTERPRETATION: The study showed that a compound teleophthalmology program in a semiurban community would be more effective but more costly than in-person examination. The findings raise the question of whether the benefits of pharmacy-based teleophthalmology in semiurban areas, where in-person examination is still available, are equivalent to those observed in remote communities. Further study is needed to investigate the impact of this program on the prevention of severe vision loss and quality of life in a semiurban setting.