Decreasing patient-reported burden of treatment: A systematic review of quantitative interventional studies.

OBJECTIVES: To describe and analyse studies aiming at quantitatively assessing the impact of interventions on patient-reported burden of treatment as an outcome (primary or secondary). METHODS: The aim of the search strategy was to identify all publications describing a medical intervention intended to reduce patient-reported burden of treatment in adult patients with long-term conditions, from January 1, 2008 to July 15, 2019. Four databases (Medline, PsycINFO, the "Trials" section of the Cochrane-Library, and OpenGrey) were searched in English, French, Spanish, Italian and Portuguese. Each identified article was reviewed and the risk of bias was assessed using a tool adapted from the Cochrane Collaboration recommendations. RESULTS: Of 641 articles retrieved, 11 were included in this review. There were nine randomized controlled trials, one non-randomized controlled trial, and one before-and-after study. The sample sizes ranged from 55 to 1,546 patients. Eight out of the eleven studies reported significant positive outcomes of the studied interventions. Reducing dosing frequency, improving background therapy, offering home care or providing easier-to-use medical devices were associated with positive outcomes. CONCLUSIONS: Only a few studies have specifically focused on decreasing the subjective burden of treatment. Small trials conducted in patients with a single specific disorder have reported positive outcomes. However, a large, high-quality study assessing the impact of a change in care process in patients with multiple morbidities did not show such results. Further studies are needed to implement this aspect of patient-centred care.

Patient involvement in healthcare workers' practices: how does it operate? A mixed-methods study in a French university hospital.

BACKGROUND: The present challenge for patient involvement is the improvement of healthcare efficiency through a deeper consideration of the patient experience. In hospitals, numerous interventions promoting patient involvement are informally implemented by healthcare workers (HCWs). The first aim of this study was to conduct an overview of hospital HCWs' experiences of the involvement of patients or their representatives. This overview included the involvement of patients in the domains of healthcare provision and support for other patients, healthcare quality and safety improvement, training and research. The second aim was to describe the challenges and conditions for the development of participative interventions by HCWs. METHODS: We conducted a mixed-methods sequential study at Nantes University Hospital from September 2017 to May 2018. To achieve the first aim, we performed a descriptive analysis of quantitative data collected via a questionnaire survey of 1290 HCWs. To achieve the second aim, we conducted a thematic analysis of qualitative data collected via eight semi-structured interviews with HCWs who reported involving patients or their representatives (family and patient association members) in healthcare. RESULTS: Among the 213 survey participants (16.5%), 133 reported a total of 424 participative interventions, mostly in the domains of care quality and safety (37%) and care provision and support (29%). The analysis of the qualitative data evidenced three types of factors determining the implementation of such interventions: the profiles of patients and their representatives, the beliefs and attitudes of HCWs, and organisational factors. While leadership from patients and HCWs was a central element in the development of patient involvement interventions, organisations' capacities to foster a sustainable partnership culture appeared to be the next challenge to promote the patient-as-partner model in health systems. Our results also highlighted numerous benefits of patient and representative involvement for patients and HCWs. CONCLUSIONS: The numerous initiatives reported show that patients and patient representatives participate alongside HCWs in hospitals. It is essential to take into account the facilitating and hindering factors of patient involvement in hospital HCWs' practices for the further development of current initiatives. Additional studies, especially from the point of view of patients, are needed to complement our findings.

Major imbalance of thyroid function after laparoscopic sleeve gastrectomy.

In patients with substituted hypothyroidism, laparoscopic sleeve gastrectomy may interfere with thyroid balance by varying body weight or by altering the absorption of hormone therapy. A 58-year-old female patient presented with a major thyroid imbalance after sleeve gastrectomy, manifesting itself in large-scale changes in thyroid stimulating hormone (TSH) levels. The transition from a tablet treatment to a liquid form alleviated burden of treatment, unfortunately without normalising TSH. Our case emphasises the importance of the understanding of hypothalamic-pituitary-thyroid feedback control mechanisms together with good galenic choice, management of associated conditions and the elimination of other causes of variations of TSH levels during the management of hypothyroid patients after sleeve gastrectomy.

[What role can doctors play in health education at school? Analysis of an original multi-professional experience]. / Rôle des médecins dans l'éducation pour la santé à l'école. Analyse d'une expérience pluriprofessionnelle originale.

OBJECTIVE: The Espace Santé Jeune (ESJ) is a health education project conducted since 2008 in a French middle school. Pupils are invited to share their experiences about health in group speaking sessions led by a general practitioner (GP) accompanied by a municipal youth worker or a teacher. This study, based on the experience of the actors, seeks to understand the role of physicians and to identify the levers of the project. METHODS: A mixed method study was conducted from January to June 2015 by focus groups, individual interviews and questionnaire. Results of the inductive analysis by grounded theory methodology were compared to the quantitative results. RESULTS: 30 participants were included in the qualitative study (20 pupils, 5 teachers, 4 GP, 1 youth worker) and 107 pupils answered the questionnaire (71% response rate). The ESJ is a space centered on the speech of young people, experienced as a moment of freedom and appreciated by 70% of participants. The role of the GPs during the sessions oscillates between "animation of debates" and "expertise", and the complementarity of the competences with the educational professionals facilitates their intervention. Beyond the sessions, the presence of the GP is perceived as essential because their status brings a global legitimacy to the project. The intervention is based on the commitment of the professionals, the multi-professionality, the coordination and the sharing of a common culture for prevention. CONCLUSION: The ESJ is an innovative experience encouraging the commitment of GPs in local public health actions.