Patients' perspectives of factors influencing active participation in healthcare interactions: A qualitative study.

OBJECTIVE: To understand patients' perspectives of factors influencing their active participation in healthcare interactions. METHODS: A descriptive qualitative approach informed by naturalistic inquiry was used to secondarily analyse interview and focus group data from a study that co-designed a communication-skills learning resource for patients. The COM-B Behaviour Model was used to explore factors that influenced patient participation in healthcare communication. Thirty-nine participants took part in either individual interviews (n = 25) or a focus group (n = 14). RESULTS: From the COM-B domains nine factors emerged: capability (personal characteristics, patient language and culture, emotion or stress arising from the interaction), opportunity (time constraints, empowering actions, patient-clinician relationship, having a support person present) and motivation (preparation prior to the interaction, perception of patient-provider power imbalance). CONCLUSION: Many of the factors influencing active patient participation are modifiable, suggesting barriers to effective communication are not insurmountable. Clinicians and patients both play a role in improving communication; effective strategies include agenda setting, cultural and communication skills training for staff, and teach-back. PRACTICE IMPLICATIONS: Clinicians must be aware of the factors influencing patient active participation in healthcare interactions. Healthcare organisations should consider providing communication-skills training for clinicians so they can implement strategies to overcome communication barriers with patients.

Description of the moderate brain injured patient and predictors of discharge to rehabilitation.

OBJECTIVE: To describe patients with moderate traumatic brain injury (TBI) treated and discharged at levels I and II trauma centers in the United States; and to describe the predictors of discharge to rehabilitation after acute care. DESIGN: Retrospective, cross-sectional, descriptive study. SETTING: Trauma centers. PARTICIPANTS: Patients with moderate TBI (N=2087; age range, 18-64 y) as reported in the 2010 National Sample Project. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Discharge destination (rehabilitation vs home with no services). RESULTS: Multivariate logistic regression models revealed that demographic, clinical, and financial characteristics influenced the likelihood of being discharged to rehabilitation. Increased age, increased severity, Medicare use, longer length of stay, and trauma center locations in the Midwest and Northeast all increased the likelihood of discharge to rehabilitation. CONCLUSIONS: The decision to discharge a person with moderate TBI from acute care to rehabilitation appears to be based on factors other than just clinical need. These findings should be considered in creating more equitable access to postacute rehabilitation services for patients with moderate TBI because they risk long-term physical and cognitive problems and have the potential for productive lives with treatment.

Web-based portfolios for pharmaceutical care plans during advanced pharmacy practice experiences.

OBJECTIVE: To implement and assess a Web-based patient care portfolio system for development of pharmaceutical care plans by students completing advanced pharmacy practice experiences (APPEs) throughout a statewide preceptor network. DESIGN: Using a Web database, students in APPEs documented 6 patient cases within 5 disease state categories. Through discussion of the disease states and inclusion of patient information such as problems, desired outcomes, and interventions, a complete pharmaceutical care plan was developed for each patient. ASSESSMENT: Student interventions were compared by geographical regions to assess continuity of patient care activities by students. Additionally, students completed an evaluation of the portfolio course to provide feedback on the portfolio process. Students documented an average of 1.8 therapeutic interventions per patient case and documented interventions in all geographical regions. The majority of students indicated that the portfolio process improved their ability to develop a pharmaceutical care plan. CONCLUSION: The Web-based patient care portfolio process assisted with documentation of compliance with Accreditation Council of Pharmacy Education (ACPE) standards and College of Pharmacy Competency Statements. Students indicated the portfolio process was beneficial in developing skills needed for creating pharmaceutical care plans.

Development of the purposeful action medication-taking questionnaire.

This three-phase study describes the development and psychometric properties of the Medication-Taking Questionnaire (MTQ) to measure the purposeful action domain (reasons individuals decide to accept medication treatment) in the medication adherence model for hypertension. During Phase I, items were evaluated for content validity and clarity. Item analysis, internal consistency, and exploratory factor analysis were preformed during Phase II to finalize the MTQ: Purposeful Action as 12 items and 2 subscales (treatment benefits and medication safety). Phase III evaluated the MTQ: Purposeful Action for temporal stability and construct validity. The final version MTQ: Purposeful Action demonstrated good internal consistency, temporal stability, and construct validity. The MTQ: Purposeful Action appears to have good psychometric characteristics that represent the decision-making process for adherence in medication treatment for hypertension.

Portrait of occupational therapy.

The profession of occupational therapy promotes individuals to achieve health and wellness through engagement in meaningful occupations of daily living. This occupation-focused profession plays a critical role in health care in a multitude of settings with a wide range of clients. The paper highlights a global overview of the philosophies of occupational therapy, the current international practices in occupational therapy, the education of therapists, and the roles of law and professional societies that govern the practice of occupational therapy.

Cognitive impairment after unilateral hemispheric injury of congenital or adult origin.

OBJECTIVE: The purpose of this study was to assess and compare cognitive functioning in adults with unilateral hemispheric injury due to either congenital damage or an ischemic event in young adulthood. METHOD: Adults with cerebral palsy resulting from left hemispheric brain damage were compared with adults who had a unilateral stroke in either the left or the right hemisphere. Our primary interest was to determine the impact on hemispheric dominance as revealed by dichotic listening, a task that assesses the bias for preferential listening and processing of sounds. Performance also was determined on a language-related task (word finding) and a spatial task (dot localization). RESULTS: Scores on the Quick Neurological Screening Test indicated that all participants demonstrated significant neuromotor deficits, whereas scores on the Barthel Index indicated that the participants were functional in basic activities of daily living. On cognitive assessments, healthy control participants demonstrated a pronounced left-hemisphere dominance and right-ear advantage; participants with injury to the left hemisphere showed a strong shift toward a right-hemisphere and left-ear dominance. In particular, injury of congenital origin appeared to foster this neural reorganization and localization of language-related functions into the healthy hemisphere. This shift was associated with a deterioration of performance on both the language and the spatial tasks. CONCLUSION: The importance of appreciating subtle deficits after unilateral injury is important in therapy. The dichotic listening test may provide a simple and useful means for evaluating persistent unilateral brain dysfunction in the clinical setting.