ABSTRACT
From its inception in 1999, the National Institute for Health and Care Excellence (NICE) committed to including the expertise, experiences, and perspectives of lay people, patients and carers, and patient organizations in its health technology assessments (HTAs). This is our story of patient involvement in HTA: from early methods designed for use when assessing medicines, widening to address the different requirements of HTAs for interventional procedures, medical technologies, and diagnostic technologies. We also chart the evolution and development of all our patient involvement methods over the past 20 years through regular evaluation and by responding to external challenge. However, we know that processes and methods alone are not enough. Through case studies we demonstrate the value of patient involvement in HTA and highlight the unique perspectives and experiences that patients bring to HTA committees. Finally, we discuss the underpinning principles and commitments that have made NICE a world leader in delivering meaningful and legitimate patient involvement.
Subject(s)
Decision Making , Patient Participation/methods , State Medicine/organization & administration , Technology Assessment, Biomedical/organization & administration , Antibodies, Monoclonal, Humanized/therapeutic use , Ascites/therapy , Atrial Fibrillation/physiopathology , Cluster Headache/therapy , Colitis, Ulcerative/drug therapy , Electric Stimulation Therapy/methods , Gastrointestinal Agents/therapeutic use , Heart Valve Diseases/physiopathology , Humans , Monitoring, Ambulatory/psychology , Suction/methods , United KingdomABSTRACT
BACKGROUND: Smart insole technologies that provide biofeedback on foot health can support foot-care in adults with diabetes. However, the factors that influence patient uptake and acceptance of this technology are unclear. Therefore, the aim of this mixed-methods study was to use an established theoretical framework to determine a model of psychosocial factors that best predicts participant intention to use smart insoles. METHODS: Fifty-three adults with diabetes from regional Australia completed the validated Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Multiple regression analysis was used to determine the psychosocial factors that best predict behavioural intention to adopt a smart insole. Additionally, a focus group was conducted and thematic analysis was performed to explore barriers and enablers to adopting this technology. RESULTS: The multiple regression model that best predicted intention to adopt the smart insole (adjusted R2 = 0.51, p < 0.001) identified that self-efficacy (ß = 0.67, p = 0.001) and attitude (ß = 0.72, p < 0.001) were significant predictors of behavioural intention, while effort expectancy (ß = - 0.52, p = 0.003) and performance expectancy (ß = - 0.40, p = 0.040) were moderating factors. Thematic analysis illustrates the importance of attitude and self-efficacy on participants' behavioural intentions, influenced by participant's belief in the device's clinical efficacy and anticipated effort expectancy. CONCLUSIONS: This mixed-methods study demonstrates that attitude, self-efficacy, performance expectancy and effort expectancy combine to predict intention to adopt smart insole technology. Clinicians should consider these psychosocial factors when they prescribe and implement smart soles with patients at high risk of foot ulceration.
Subject(s)
Diabetic Foot/prevention & control , Foot Orthoses , Health Behavior , Patient Compliance/psychology , Shoes , Wearable Electronic Devices/psychology , Aged , Attitude to Health , Australia , Biofeedback, Psychology , Diabetes Mellitus/rehabilitation , Female , Focus Groups , Humans , Intention , Male , Middle Aged , Monitoring, Ambulatory/instrumentation , Monitoring, Ambulatory/psychology , Smart Materials , Telemedicine/instrumentation , Telemedicine/methodsABSTRACT
Este artículo presenta un estudio intensivo, combinando métodos estadísticos diversos,del resultado y el proceso de los tratamientos psicoterapéuticos llevados a cabo en elServei dAssessorament i Assistència Psicológica Blanquerna de Barcelona, y analizapormenorizadamente las relaciones entre resultado (mejoría) y proceso (alianza terapéutica).Más concretamente (a) el proceso terapéutico en términos de la relación entrealianza terapéutica y resultado de la psicoterapia; y (b) los efectos de las rupturas de laalianza terapéutica y el empeoramiento sintomático sobre el resultado y el proceso dela terapia. Los clientes incluidos en este estudio fueron 239 y los instrumentos fueron elCuestionario de Evaluación de Resultados CORE Outcome Measure y la versión reducidadel WAI (Working Alliance Inventory) para la evaluación de proceso. Los resultados,además del buen resultado de la terapia y el mantenimiento de los cambios, demostraronla importancia de diferentes aspectos de la alianza terapéutica como predictores delresultado y el proceso terapéutico
This paper presents an intensive study that combines statistical methods to test theoutcome and process of the psychotherapeutic treatments at the Servei dAssessoramenti Assistència Psicológica Blanquerna in Barcelona, and it analyzes in detail the relatioship between outcome (improvement) and process (therapeutic alliance). Specifically the study analyzes (a) the psychotherapeutic process in terms of the relationship betweentherapeutic alliance and therapy outcome, and (b) the effect of therapeutic alliance rupturesand symptomatic worsening over therapy outcome and process. The clients included inthis study were 239 and the assessment instruments were the CORE Outcome Measureand the reduced version of the Working Alliance Inventory. Results indicate the goodoutome of therapy and the importante of different aspects of the therapeutic alliance as predictors of the therapeutic process (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Child , Psychotherapy/methods , Cognitive Behavioral Therapy/methods , Cognitive Science/methods , Surveys and Questionnaires , Monitoring, Ambulatory/methods , Monitoring, Ambulatory/psychology , Analysis of Variance , Treatment Outcome , Outcome Assessment, Health Care/methods , Interview, Psychological/methods , Psychotherapy/instrumentation , Psychotherapy/standards , Bias , Evaluation of Results of Therapeutic Interventions/methodsABSTRACT
Los Trastornos de la Personalidad Límite, (TPL) han ido ganando en importancia como patología psiquiátrica debido a las características clínicas de los pacientes, que hacen enormemente difícil tratarles, por la tendencia a interrumpir los tratamientos que se les proponen y a recaer, por las repercusiones que generan desde el punto de vista socio sanitario así como el elevado consumo de servicios que generan, lo que les ha llevado a convertirse en un grave problema de salud pública. Se describe a continuación un resumen de un modelo de tratamiento psicoterapéutico para su implementación en un contexto multidisciplinar y dentro de una red de servicios de salud mental que actúen de forma coordinada, haciendo especial hincapié en las características técnicas de la psicoterapia a emplear. Se revisan básicamente el Modelo de O. Kernberg de la Psicoterapia Focalizada en la Transferencia complementado con el Programa Ambulatorio Intensivo diseñado y puesto en práctica por J. Gunderson. Se complementa con una breve referencia al Modelo de M. Linehan de la DBT ( Dialectic Behavioural Psychotherapy) (AU)
Borderline personality disorders (BPD) have become increasingly relevant as a psychiatric disorder because of the clinical characteristics of patient (very hardy to treat), the patient tendency to discontinuation and relapse, their socio-medical impact and the high service use the generate. This turns them into a serious public health problem. A model of psychotherapeutic treatment is described to be implemented in a multidisciplinary context within a net of mental health services working in a coordinate way. The emphasis is focused on the technical characteristics of the psychotherapy. O. Kernberg´s Transference Focused Psychotherapy model along with J. Gunderson´s Intensive Outpatient Program are described. In addition, the Dialectic Behavioural Therapy model is briefly outlined (AU)