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1.
BMC Complement Altern Med ; 19(1): 305, 2019 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-31711478

RESUMEN

BACKGROUND: Patient-centered culturally sensitive health care (PC-CSHC) has emerged as a primary approach to health care. This care focuses on the cultural diversity of the patients rather than the views of the health care professionals. PC-CSHC enables the patient to feel comfortable, respected, and trusted in the health care delivery process. As users of traditional and complementary medicine (T&CM) rarely inform their conventional health care providers of such use, the providers need to identify the users of T&CM themselves to avoid negative interaction with conventional medicine and to be able to provide them with PC-CSHC. Since the patterns of traditional medicine (TM) use are different to those of complementary medicine (CM), the aim of this study was to investigate the prevalence, and the health- and sociodemographic associations for visits to TM- and CM providers in an urban population. METHOD: The data were collected through two self-administrated questionnaires from the seventh survey of the Tromsø Study, a population-based cohort study conducted in 2015-2016. All inhabitants of Tromsø aged 40 or above were invited (n = 32,591) and n = 21,083 accepted the invitation (response rate 65%). Pearson chi-square tests and one-way ANOVA tests were used to describe differences between the groups whereas binary logistic regressions were used for adjusted values. RESULTS: The results revealed that 2.5% of the participants had seen a TM provider, 8.5% had seen a CM provider whereas 1% had visited both a TM and a CM provider during a 12-month period. TM users tended to be older, claim that religion was more important to them, have poorer economy and health, and have lower education compared to CM users. We found that more than 90% of the participants visiting T&CM providers also used conventional medicine. CONCLUSION: A considerable number of the participants in this study employed parallel health care modalities including visits to conventional, traditional, and complementary medicine providers. To offer patient-centered culturally sensitive health care that is tailored to the patients' treatment philosophy and spiritual needs, conventional health care providers need knowledge about, and respect for their patients' use of parallel health care systems.


Asunto(s)
Terapias Complementarias/psicología , Medicina Tradicional/psicología , Pacientes/psicología , Adulto , Anciano , Atención Ambulatoria/psicología , Atención Ambulatoria/estadística & datos numéricos , Estudios de Cohortes , Terapias Complementarias/estadística & datos numéricos , Demografía , Femenino , Personal de Salud/psicología , Humanos , Masculino , Medicina Tradicional/estadística & datos numéricos , Persona de Mediana Edad , Noruega , Pacientes/estadística & datos numéricos , Prevalencia , Religión , Confianza
2.
Br J Nurs ; 28(20): S10-S18, 2019 Nov 14.
Artículo en Inglés | MEDLINE | ID: mdl-31714826

RESUMEN

Primary surgical abdominal wounds are usually covered with a dressing. However, little is known about the practical issues and costs around these dressings. This study aimed to provide an in-depth description of patients' and health professionals' perspectives on the clinical and practical issues associated with standard and novel dressing (glue-as-a-dressing) use on primary surgical wounds, and to establish whether and how their experience compares with these perspectives. During semi-structured interviews, patients and health professionals discussed their positive experience of glue-as-a-dressing and no dressing around six themes: wound contamination and infection, wound healing, wound care, physical protection afforded by simple dressings, the potential psychological impact of an exposed wound, and ability to carry out everyday tasks. Current views on the practice of dressings for primary abdominal wounds are influenced by ingrained clinical practice. These views can be challenged when exposed to novel dressing strategies or as new evidence of the clinical effect of dressing strategies emerges.


Asunto(s)
Abdomen/cirugía , Vendajes , Personal de Salud/psicología , Pacientes/psicología , Herida Quirúrgica/terapia , Adolescente , Adulto , Actitud del Personal de Salud , Actitud Frente a la Salud , Femenino , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Pacientes/estadística & datos numéricos , Investigación Cualitativa
3.
J Prev Med Public Health ; 52(5): 323-332, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31588702

RESUMEN

OBJECTIVES: The aim of this study was to describe general practitioners (GPs)' opinions and practices of preventive care and patients' opinions, attitudes, and behaviors towards prevention. METHODS: The data stemmed from a cross-sectional national survey on prevention conducted in Switzerland from 2015 to 2016. In total, 170 randomly drawn GPs and 1154 of their patients participated. The GPs answered an online questionnaire and the patients answered a questionnaire administrated by fieldworkers present at their practices. RESULTS: Both patients and GPs agreed that delivering preventive care is the dedicated role of a GP. It appeared that beyond classical topics of prevention such as cardiovascular risk factors, other prevention areas (e.g., cannabis consumption, immunization, occupational risks) were scarcely covered by GPs and reported as little-known by patients. In addition, GPs seemed to use a selective approach to prevention, responding to the clinical context, rather than a systematic approach to health promotion. The results also highlight possibilities to improve prevention in family medicine through options such as more supportive tools and public advertising, more time and more delegated tasks and, finally, a more recognized role. CONCLUSIONS: Despite an unfavorable context of prevention within the healthcare system, preventive care in family medicine is reasonably good in Switzerland. However, some limitations appear regarding the topics and the circumstances of preventive care delivery. A global effort is needed to implement necessary changes, and the responsibility should be broadened to other stakeholders.


Asunto(s)
Actitud del Personal de Salud , Medicina Familiar y Comunitaria , Médicos Generales/psicología , Pacientes/psicología , Medicina Preventiva/normas , Actitud Frente a la Salud , Estudios Transversales , Femenino , Médicos Generales/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Pacientes/estadística & datos numéricos , Encuestas y Cuestionarios , Suiza
4.
Int J Equity Health ; 18(1): 150, 2019 10 11.
Artículo en Inglés | MEDLINE | ID: mdl-31604437

RESUMEN

BACKGROUND: Type 1 diabetes is a complex chronic condition which requires lifelong treatment with insulin. Health outcomes are dependent on ability to self-manage the condition. Socioeconomic inequalities have been demonstrated in access to treatment and health outcomes for adults with type 1 diabetes; however, there is a paucity of research exploring how these disparities occur. This study explores the influence of socioeconomic factors in gaining access to intensive insulin regimens for adults with type 1 diabetes. METHODS: We undertook a qualitative descriptive study informed by a phenomenological perspective. In-depth face-to-face interviews were conducted with 28 patients and 6 healthcare professionals involved in their care. The interviews were analysed using a thematic approach. The Candidacy theory for access to healthcare for vulnerable groups framed the analysis. RESULTS: Access to intensive insulin regimens was through hospital-based specialist services in this sample. Patients from lower socioeconomic groups had difficulty accessing hospital-based services if they were in low paid work and because they lacked the ability to navigate the healthcare system. Once these patients were in the specialist system, access to intensive insulin regimens was limited by non-alignment with healthcare professional goals, poor health literacy, psychosocial problems and poor quality communication. These factors could also affect access to structured diabetes education which itself improved access to intensive insulin regimens. Contact with diabetes specialist nurses and attendance at structured diabetes education courses could ameliorate these barriers. CONCLUSIONS: Access to intensive insulin regimens was hindered for people in lower socioeconomic groups by a complex mix of factors relating to the permeability of specialist services, ability to navigate the healthcare system and patient interactions with healthcare providers. Improving access to diabetes specialist nurses and structured diabetes education for vulnerable patients could lessen socioeconomic disparities in both access to services and health outcomes.


Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Disparidades en Atención de Salud/economía , Insulina/uso terapéutico , Adolescente , Adulto , Anciano , Actitud del Personal de Salud , Actitud Frente a la Salud , Femenino , Personal de Salud/psicología , Humanos , Insulina/economía , Masculino , Persona de Mediana Edad , Pacientes/psicología , Pacientes/estadística & datos numéricos , Investigación Cualitativa , Factores Socioeconómicos , Adulto Joven
5.
Niger Postgrad Med J ; 26(4): 211-215, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31621660

RESUMEN

Introduction: Recent evidence suggests that rates of drug use and abuse in Nigeria exceed the global average. There is a strong treatment demand for psychoactive drug use disorders in Nigeria; however, it is not known whether available treatment facilities are attending to the array of treatment needs. This audit compares the pattern of presentations at a tertiary facility with a community-based survey. Methods: A review of cases (n = 212) seen at a regional drug treatment facility over a 4-year period, using local data retrieved from the Nigerian Epidemiological Network of Drug Use (NENDU) and comparison with data from the recently published national drug use survey. Results: Nine out of ten clients seen were male (93.4%). About half (49.5%) of the clients used psychoactive substances for the first time between ages 10 and 19 years. Cannabis was the primary drug of use overall and also among males, while females were more likely to present with opiate abuse. Over half had a co-occurring physical or mental disorder, and a minority had received testing for hepatitis C in the past 12 months. Conclusion: Although patterns of drug abuse presentations were consistent with findings from a national community-based survey, there was an under-representation of females in treatment. Implications for policy development and practice are discussed.


Asunto(s)
/efectos adversos , Trastornos Mentales/epidemiología , Pacientes/estadística & datos numéricos , Trastornos Relacionados con Sustancias/terapia , Adolescente , Adulto , Distribución por Edad , Alcoholismo/epidemiología , Alcoholismo/rehabilitación , Niño , Comorbilidad/tendencias , Estudios Transversales , Femenino , Hospitales Psiquiátricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Tiempo de Internación/tendencias , Masculino , Abuso de Marihuana/epidemiología , Trastornos Mentales/rehabilitación , Persona de Mediana Edad , Nigeria/epidemiología , Pacientes/psicología , Factores de Riesgo , Distribución por Sexo , Factores Socioeconómicos , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Encuestas y Cuestionarios , Adulto Joven
6.
Artículo en Inglés | MEDLINE | ID: mdl-31505892

RESUMEN

This study investigated the effect of applying a customized diabetes education program through pattern management (PM), using continuous glucose monitoring system (CGMS) results, on individual self-care behaviors and self-efficacy in patients with type 2 diabetes mellitus. Patients with type 2 diabetes who had never received diabetes education, enrolled from March to September 2017, were sequentially assigned to either PM education or control groups. In the PM education group, the CGMS test was first conducted one week before diabetes education and repeated three times by PM in order to obtain data on self-care behaviors and self-efficacy. These results were then compared before and after education at three and six months. The control group received the traditional diabetes education. Self-efficacy showed statistically significant interactions between the two groups over time, indicating a significant difference in the degree of self-efficacy between the PM education and control groups. Diabetes education by PM using CGMS result analysis improved life habits with a positive influence on self-care behaviors and self-efficacy for diabetes management. Further studies are needed to further develop and apply individual diabetes education programs in order to sustain the effects of self-care behaviors and self-efficacy in patients with diabetes who experience a decrease in self-efficacy after three months of education.


Asunto(s)
Diabetes Mellitus Tipo 2/terapia , Educación en Salud/métodos , Educación del Paciente como Asunto/estadística & datos numéricos , Autocuidado/estadística & datos numéricos , Autoeficacia , Adulto , Anciano , Automonitorización de la Glucosa Sanguínea , Femenino , Educación en Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Pacientes/estadística & datos numéricos , República de Corea , Adulto Joven
7.
Ann Agric Environ Med ; 26(3): 469-503, 2019 Sep 19.
Artículo en Inglés | MEDLINE | ID: mdl-31559810

RESUMEN

OBJECTIVES: The aim of the study is to determine the scale of interregional migrating patients' hospitalizations in Poland in 2013-2017, as well as their demographic and medical factors, total costs and time changes. MATERIAL AND METHODS: Data from the NHF (National Health Fund) regarding hospitalizations in a given province of patients registered in another province in Poland in 2013-2017 were statistically analyzed. Times series analyses as well as coefficients of correlation, determination and variation were used. RESULTS: The number of patients hospitalized outside their regional registration and the cost of their hospitalization increased from year-to-year during 2013-2017. There was a large variation in provinces in terms of inflow of patients and costs of their hospitalization, while there was only a small variation in terms of outflow of patients and costs of their hospitalization in the analyzed years. Among the patients hospitalized outside the province where they were registered, there were more women then men, while the age group was dominated by 60-year-olds and their share in the subsequent years increased, while the share of other age groups remained unchanged or decreased. The most and increasingly more from year-to-year hospitalizations outside the regional registration were due to neoplasms and diseases of the circulatory system. CONCLUSIONS: The results of the study may significantly contribute to the proper planning of securing the health needs of the inhabitants of particular regions, and to improving the quality and economic efficiency of health services in individual NHF branches.


Asunto(s)
Hospitalización/economía , Pacientes/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Conducta de Elección , Femenino , Costos de Hospital , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Masculino , Persona de Mediana Edad , Pacientes/estadística & datos numéricos , Polonia , Factores de Tiempo , Adulto Joven
8.
Rev. bras. cir. plást ; 34(3): 310-314, jul.-sep. 2019. ilus, tab
Artículo en Inglés, Portugués | LILACS | ID: biblio-1047144

RESUMEN

Introdução: A demanda por cirurgia plástica tem aumentado progressivamente, dentre os procedimentos mais frequentes estão as cirurgias de mamas (aumento e redução). Métodos: Estudo retrospectivo de prontuários de pacientes que foram submetidas a mamoplastia redutora e de aumento, no período de janeiro de 2015 a junho de 2018, no Hospital PUC-Campinas. Resultados: Foram realizadas 13 mamoplastias de aumento e 275 mamoplastias redutoras. Das 288 cirurgias realizadas duas (n=2) evoluíram com TEP (tromboembolismo pulmonar). Conclusão: Portanto, a incidência de fenômenos tromboembólicos em mamoplastias de aumento e redutoras mostrou-se baixa no presente estudo, assim como na literatura. Já as pacientes acometidas no estudo eram consideradas de baixo risco para complicação tromboembólica, de acordo com protocolos de profilaxia, devendo-se atentar para tais fenômenos no pós-operatório. Ainda são necessários mais estudos para padronização do uso de medidas de profilaxia do tromboembolismo venoso.


Introduction: The demand for plastic surgery has progressively increased, and breast enlargement and reduction surgeries are among the most frequent procedures. Methods: This retrospective study reviewed the medical records of patients who underwent reduction and augmentation mammoplasty between January 2015 and June 2018 at the PUC-Campinas Hospital. Results: Thirteen augmentation mammoplasties and 275 reduction mammoplasties were performed. Of the 288 patients who underwent surgeries, two patients developed postoperative pulmonary thromboembolism. Conclusion: The incidence of thromboembolic phenomena in augmentation and reduction mammoplasty is low. Patients in this study were considered at low risk for thromboembolic complications. According to prophylaxis protocols, this phenomena should be monitored postoperatively. Further studies are needed to standardize the use of venous thromboembolism prophylaxis measures.


Asunto(s)
Humanos , Femenino , Adulto , Historia del Siglo XXI , Pacientes , Embolia Pulmonar , Cirugía Plástica , Mama , Registros Médicos , Estudios Retrospectivos , Embolia y Trombosis , Trombosis de la Vena , Pacientes/estadística & datos numéricos , Embolia Pulmonar/cirugía , Embolia Pulmonar/complicaciones , Cirugía Plástica/estadística & datos numéricos , Mama/cirugía , Registros Médicos/estadística & datos numéricos , Embolia y Trombosis/cirugía , Trombosis de la Vena/cirugía , Trombosis de la Vena/complicaciones
9.
BMC Public Health ; 19(1): 1096, 2019 Aug 13.
Artículo en Inglés | MEDLINE | ID: mdl-31409317

RESUMEN

BACKGROUND: Culturally competent health care service delivery can improve health outcomes, increasing the efficiency of clinical staff, and greater patient satisfaction. We aimed to explore the experience of patients with limited English proficiency and professional interpreters in an acute hospital setting. METHODS: In-depth interviews explored the experiences of four culturally and linguistically diverse communities with regards to their recent hospitalisation and access to interpreters. We also conducted focus group with professional interpreters working. Data were analysed using an inductive thematic approach with constant comparison. RESULTS: Individual interviews were conducted with 12 patients from Greek, Chinese, Dari and Vietnamese backgrounds. Focus groups were conducted with 11 professional interpreters. Key themes emerged highlighting challenges to the delivery of health care due distress and lack of advocacy in patients. Interpreters struggled due to a reliance on family to act as interpreters and hospital staff proficiency in working with them. CONCLUSIONS: In an era of growing ethnic diversity this study confirms the complexity of providing a therapeutic relationships in contemporary health practice. This can be enhanced by training towards the effective use of professional interpreters in a hospital setting. Such efforts should be multidisciplinary and collective in order to ensure patients don't fall through the gaps with regards to the provision of culturally competent care.


Asunto(s)
Barreras de Comunicación , Asistencia Sanitaria Culturalmente Competente , Necesidades y Demandas de Servicios de Salud , Lenguaje , Adulto , Anciano , Anciano de 80 o más Años , Técnicos Medios en Salud/psicología , Técnicos Medios en Salud/estadística & datos numéricos , Australia , Diversidad Cultural , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Pacientes/psicología , Pacientes/estadística & datos numéricos , Investigación Cualitativa , Traducción
10.
J Rehabil Med ; 51(9): 665-674, 2019 Oct 04.
Artículo en Inglés | MEDLINE | ID: mdl-31414140

RESUMEN

OBJECTIVE: Despite the increasing availability of eRehabilitation, its use remains limited. The aim of this study was to assess factors associated with willingness to use eRehabilitation. DESIGN: Cross-sectional survey. SUBJECTS: Stroke patients, informal caregivers, health-care professionals. METHODS: The survey included personal characteristics, willingness to use eRehabilitation (yes/no) and barri-ers/facilitators influencing this willingness (4-point scale). Barriers/facilitators were merged into factors. The association between these factors and willingness to use eRehabilitation was assessed using logistic regression analyses. RESULTS: Overall, 125 patients, 43 informal caregivers and 105 healthcare professionals participated in the study. Willingness to use eRehabilitation was positively influenced by perceived patient benefits (e.g. reduced travel time, increased motivation, better outcomes), among patients (odds ratio (OR) 2.68; 95% confidence interval (95% CI) 1.34-5.33), informal caregivers (OR 8.98; 95% CI 1.70-47.33) and healthcare professionals (OR 6.25; 95% CI 1.17-10.48). Insufficient knowledge decreased willingness to use eRehabilitation among pa-tients (OR 0.36, 95% CI 0.17-0.74). Limitations of the study include low response rates and possible response bias. CONCLUSION: Differences were found between patients/informal caregivers and healthcare professionals. Ho-wever, for both groups, perceived benefits of the use of eRehabilitation facilitated willingness to use eRehabili-tation. Further research is needed to determine the benefits of such programs, and inform all users about the potential benefits, and how to use eRehabilitation.


Asunto(s)
Cuidadores/estadística & datos numéricos , Personal de Salud/estadística & datos numéricos , Pacientes/estadística & datos numéricos , Accidente Cerebrovascular/terapia , Telemedicina/métodos , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
11.
BMC Complement Altern Med ; 19(1): 223, 2019 Aug 22.
Artículo en Inglés | MEDLINE | ID: mdl-31438954

RESUMEN

BACKGROUND: We aimed to compare patients' and physicians' safety reporting using data from large acupuncture trials (44,818 patients) and to determine associations between patient characteristics and reporting of adverse reactions. METHODS: Six pragmatic randomized trials with an additional non-randomized study arm that included those patients who refused randomization were evaluated. Patients received acupuncture treatment for osteoarthritis of the hip or knee, chronic neck pain, chronic low back pain, chronic headache, dysmenorrhea, or allergic rhinitis or asthma. Safety outcomes were evaluated by questionnaires from both the physicians and the patients. To determine level of agreement between physicians and patients on the prevalence of adverse reactions, Cohen's kappa was used. With multilevel models associations between patient characteristics and reporting of adverse reactions were assessed. RESULTS: Patients reported on average three times more adverse reactions than the study physicians: for bleeding/haematoma, 6.7% of patients (n = 2458) vs. 0.6% of physicians (n = 255) and for pain, 1.7% of patients (n = 636) vs. 0.5% of physicians (n = 207). We found only minor agreements between patients and physicians (maximum Cohen's kappa: 0.50, 95% confidence interval [0.49;0.51] for depressive mood). Being a female and participation in the randomization were associated with higher odds of reporting an adverse reaction. CONCLUSIONS: In our study, patients' and physicians' reports on adverse reactions of acupuncture differed substantially, possibly due to differences in patients' and physicians' questionnaires and definitions. For the assessment of safety, we strongly support the inclusion of patients' and physicians' reports while ensuring standardization of data collection and definitions.


Asunto(s)
Terapia por Acupuntura/efectos adversos , Documentación/estadística & datos numéricos , Pacientes/estadística & datos numéricos , Médicos/estadística & datos numéricos , Ensayos Clínicos Controlados Aleatorios como Asunto , Adulto , Documentación/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Autoinforme
12.
Public Health ; 175: 60-67, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31401252

RESUMEN

OBJECTIVES: The objective of this study is to increase understanding of knowledge, attitudes, and preventative practices regarding ischemic heart disease (IHD) in sub-Saharan Africa in order to develop patient-centered interventions to improve care and outcomes. STUDY DESIGN: This is a prospective observational study. METHODS: Adult patients presenting with chest pain or shortness of breath to an emergency department in northern Tanzania were enrolled. A questionnaire was adapted from existing knowledge attitude and practice surveys regarding cardiovascular disease and the WHO STEPS instrument. Individual five-year risk of cardiovascular event was determined by validated models based on age, sex, systolic blood pressure, body mass index, diabetes, and smoking status. An IHD knowledge score was calculated by giving one point for each correct response to the knowledge-related items, with a maximum score of 10. Associations between IHD knowledge and patient characteristics were assessed by Welch's t-test. RESULTS: A total of 349 patients were enrolled, with median interquartile range (IQR) age 60 (45, 72) years. Of participants, 259 (74.2%) had hypertension, and 228 (65.3%) had greater than 10% five-year risk of cardiovascular event. The mean (SD) knowledge score was 4.8 (3.3). The majority of respondents (224, 64.2%) recognized obesity as a risk factor for heart attack, while a minority (34, 9.7%) knew that a daily aspirin could reduce the risk of cardiovascular event. Greater IHD knowledge was associated with younger age (P = 0.045) and higher levels of education (P < 0.001) but not higher risk of cardiovascular disease (P = 0.123). Most respondents expressed a willingness to diet to improve their health (322, 92.3%) and a preference for treatment from a physician rather than a traditional healer for a heart attack (321, 92.0%). A minority of patients reported exercising regularly (88, 25.2%) or seeing a doctor routinely for checkups (100, 28.7%). CONCLUSIONS: High-risk emergency department patients in northern Tanzania have moderate knowledge regarding IHD but do not consistently engage in healthy preventive practices. Patient-centered interventions are needed to improve IHD knowledge and practices in high-risk populations.


Asunto(s)
Servicio de Urgencia en Hospital , Conocimientos, Actitudes y Práctica en Salud , Isquemia Miocárdica/prevención & control , Pacientes/psicología , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pacientes/estadística & datos numéricos , Estudios Prospectivos , Factores de Riesgo , Encuestas y Cuestionarios , Tanzanía
13.
BMC Palliat Care ; 18(1): 56, 2019 Jul 12.
Artículo en Inglés | MEDLINE | ID: mdl-31299956

RESUMEN

BACKGROUND: Systematic research into palliative care (PC) for people with substance use disorder (SUD) and multiple problems is scarce. The existing literature shows problems in the organizational structure of this care, e.g., lack of clear care pathways. Furthermore, negative attitudes of healthcare professionals (HCPs) and stigmatization surrounding SUD, and patients' care-avoidance and non-disclosure of substance use are hindering factors in providing timely and person-centered PC. Furthermore, the experiences and needs of patients and proxies themselves are unknown. Therefore, this study aims to explore which problems and needs patients with SUD and multiple problems, and their proxies, experience in a PC phase. METHODS: Data-collection of this qualitative study consisted of semi-structured interviews with patients with SUD and multiple problems in a PC phase, and their proxies, about their experiences in PC and their well-being. Interviews were inductively analyzed. RESULTS: Nine patients and three proxies were included. Six patients suffered from COPD, one patient from cirrhosis of the liver and two patients from both. Seven patients stayed in a nursing home and two had a room in either a social care service (hostel) or an assisted living home where medical care was provided. Five themes were identified: 1) healthcare delivery (including HCPs behaviour and values); 2) end-of-life (EOL) preferences (mostly concerning only the individual patient and the 'here-and-the-now'); 3) multidimensional problems; 4) coping (active and passive) and; 5) closed communication. Proxies' experiences with healthcare differed. Emotionally, they were all burdened by their histories with the patients. CONCLUSIONS: This study shows that talking about and anticipating on PC with this patient-group appears hard due to patients' closed and avoiding communication. Furthermore, some of patients' EOL-preferences and needs, and coping-strategies, seem to differ from the more generally-accepted ideas and practices. Therefore, educating HCPs in communicating with this patient-group, is needed.


Asunto(s)
Cuidadores/psicología , Personal de Salud/psicología , Cuidados Paliativos/normas , Trastornos Relacionados con Sustancias/complicaciones , Cuidadores/estadística & datos numéricos , Personal de Salud/estadística & datos numéricos , Humanos , Cuidados Paliativos/métodos , Cuidados Paliativos/estadística & datos numéricos , Satisfacción del Paciente , Pacientes/psicología , Pacientes/estadística & datos numéricos , Investigación Cualitativa , Trastornos Relacionados con Sustancias/psicología
14.
JMIR Mhealth Uhealth ; 7(7): e13844, 2019 07 02.
Artículo en Inglés | MEDLINE | ID: mdl-31267978

RESUMEN

BACKGROUND: In the emerging era of digitalization and electronic health, skin cancer-related apps represent useful tools to support dermatologic consultation and examination. Yet, little is known about how patients perceive the value of such apps. OBJECTIVE: The aim of this study was to investigate patient attitudes and their awareness toward skin cancer-related apps. METHODS: A cross-sectional study including 200 patients from the oncological outpatient unit was conducted at the University Hospital (LMU Munich, Germany) between September and December 2018. Patients were asked to complete a self-administered questionnaire on the popularity and usefulness of health-related and skin cancer-related apps. A descriptive analysis was performed with the expression of categorical variables as frequencies and percentages. For continuous variables, the median and range were indicated. Contingency tables and chi-square tests were performed to investigate associations between sociodemographic data and selected items of the questionnaire. RESULTS: A total of 98.9% (195/197) of patients had never used skin cancer-related apps or could not remember. In 49.7% (93/187) of cases, patients were unsure about the usefulness of skin cancer apps, whereas 42.6% (78/183) thought that skin cancer apps could supplement or support the professional skin examination performed by a physician. However, 47.9% (90/188) were interested in acquiring more information by their dermatologists about skin cancer apps. Young age (P=.002), male gender (P=.02), a previous history of melanoma (P=.004), and higher educational level (P=.002) were significantly associated with a positive attitude. Nevertheless, 55.9% (105/188) preferred a printed patient brochure on skin cancer to downloading and using an app. CONCLUSIONS: The experience and knowledge of skin cancer-related apps was surprisingly low in this population, although there was a high general interest in more information about such apps. Printed patient brochures were the preferred information source.


Asunto(s)
Aplicaciones Móviles/normas , Pacientes/psicología , Cuidados de la Piel/instrumentación , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Alfabetización en Salud/normas , Alfabetización en Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Aplicaciones Móviles/estadística & datos numéricos , Pacientes/estadística & datos numéricos , Cuidados de la Piel/métodos , Cuidados de la Piel/normas , Neoplasias Cutáneas/prevención & control , Neoplasias Cutáneas/psicología , Encuestas y Cuestionarios
15.
JMIR Mhealth Uhealth ; 7(7): e13817, 2019 07 10.
Artículo en Inglés | MEDLINE | ID: mdl-31293246

RESUMEN

BACKGROUND: Mobile phones and tablets are being increasingly integrated into the daily lives of many people worldwide. Mobile health (mHealth) apps have promising possibilities for optimizing health systems, improving care and health, and reducing health disparities. However, health care apps often seem to be underused after being downloaded. OBJECTIVE: The aim of this paper is to reach a better understanding of people's perceptions, beliefs, and experience of mHealth apps as well as to determine how highly they appreciate these tools. METHODS: A systematic review was carried out on qualitative studies published in English, on patients' perception of mHealth apps between January 2013 and June 2018. Data extracted from these articles were synthesized using a meta-ethnographic approach and an interpretative method. RESULTS: A total of 356 articles were selected for screening, and 43 of them met the inclusion criteria. Most of the articles included populations inhabiting developed countries and were published during the last 2 years, and most of the apps on which they focused were designed to help patients with chronic diseases. In this review, we present the strengths and weaknesses of using mHealth apps from the patients' point of view. The strengths can be categorized into two main aspects: engaging patients in their own health care and increasing patient empowerment. The weaknesses pointed out by the participants focus on four main topics: trustworthiness, appropriateness, personalization, and accessibility of these tools. CONCLUSIONS: Although many of the patients included in the studies reviewed considered mHealth apps as a useful complementary tool, some major problems arise in their optimal use, including the need for more closely tailored designs, the cost of these apps, the validity of the information delivered, and security and privacy issues. Many of these issues could be resolved with more support from health providers. In addition, it would be worth developing standards to ensure that these apps provide patients accurate evidence-based information.


Asunto(s)
Antropología Cultural/métodos , Aplicaciones Móviles/normas , Pacientes/psicología , Percepción , Investigación Cualitativa , Antropología Cultural/estadística & datos numéricos , Humanos , Aplicaciones Móviles/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Pacientes/estadística & datos numéricos , Telemedicina/instrumentación , Telemedicina/métodos , Telemedicina/normas
16.
BMC Infect Dis ; 19(1): 662, 2019 Jul 25.
Artículo en Inglés | MEDLINE | ID: mdl-31345168

RESUMEN

BACKGROUND: This study aimed to determine the prevalence of infectious diseases and risk factors for one-year mortality in elderly emergency department (ED) patients. METHODS: A retrospective cohort study of patients aged 65 and over who visited the ED of one urban teaching hospital in Bangkok, Thailand and who were diagnosed with infectious diseases between 1 January 2016 and 30 June 2016. RESULTS: There were 463 elderly patients who visited ED with infectious diseases, accounting for 14.5% (463/3,196) of all elderly patients' visits. The most common diseases diagnosed by emergency physicians (EPs) were pneumonia [151 (32.6%) patients] followed by pyelonephritis [107 (23.1%) patients] and intestinal infection [53 (11.4%) patients]. Moreover, 286 (61.8%) patients were admitted during the study period. The in-hospital mortality rate was 22.7%. 181 (39.1%) patients died within 1 year. Our multivariate analysis showed that age 85 years and older [odds ratio (OR) = 1.89; 95% confidence interval (CI): 1.36-2.63], Charlson Co-morbidity Index score ≥ 5 (OR = 3.51; 95% CI2.14-5.77), lactate ≥4 mmol/l (OR = 2.66;95% CI 1.32-5.38), quick Sequential Organ Failure Assessment (qSOFA) score ≥ 2 (OR = 5.46; 95% CI 2.94-10.12), and platelet count < 100,000 cells/mm3 (OR = 3.19; 95% CI 1.15-8.83) were associated with 1-year mortality. CONCLUSIONS: In one middle-income country, infectious diseases account for 14.5% of elderly ED patients. Almost two-thirds of patients presenting to ED with infection are admitted to hospital. One-third of elderly ED patients with infection died within 1 year. Age ≥ 85 years, Charlson Co-morbidity Index score ≥ 5, lactate ≥4 mmol/l, qSOFA score ≥ 2, and platelet count < 100,000 cells/mm3 predicted 1-year mortality rate.


Asunto(s)
Enfermedades Transmisibles/mortalidad , Servicio de Urgencia en Hospital/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Enfermedades Transmisibles/economía , Enfermedades Transmisibles/epidemiología , Femenino , Mortalidad Hospitalaria , Hospitalización , Humanos , Renta , Masculino , Oportunidad Relativa , Pacientes/estadística & datos numéricos , Prevalencia , Curva ROC , Estudios Retrospectivos , Factores de Riesgo , Tailandia/epidemiología
17.
Br J Nurs ; 28(14): S4-S14, 2019 Jul 25.
Artículo en Inglés | MEDLINE | ID: mdl-31348702

RESUMEN

BACKGROUND: the literature on the patient experience of living with a central venous access device (CVAD) is growing, but remains sparse. It suggests that patients accept having a CVAD as it should reduce episodes of repeated cannulations. However, a recent doctoral study found the reality did not live up to this hope. AIM: the study objective was to uncover the global, cross-disease experience of patients with CVADs. METHOD: an online survey was sent to an international sample of people living with CVADs. FINDINGS: 74 people from eight countries responded. Respondents corroborated the PhD findings: painful cannulation attempts continued after CVAD insertion because of a lack of clinical knowledge. Participants lost trust in clinicians and feared complications due to poor practice. CONCLUSION: clinicians often lack the necessary skills to care and maintain CVADs. This leads to a negative patient experience.


Asunto(s)
Cateterismo Venoso Central/instrumentación , Catéteres Venosos Centrales , Competencia Clínica/normas , Personal de Salud/normas , Pacientes/psicología , Adulto , Anciano , Cateterismo Venoso Central/efectos adversos , Catéteres Venosos Centrales/efectos adversos , Femenino , Humanos , Internacionalidad , Masculino , Persona de Mediana Edad , Pacientes/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
18.
BMC Health Serv Res ; 19(1): 459, 2019 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-31286957

RESUMEN

BACKGROUND: Wait time, defined as time spent in the waiting and exam rooms waiting to see a provider, is a key quality metric in a number of national patient experience surveys. However, the literature on wait time does not show a consistent correlation between long waits and worse overall patient care experiences. Herein, we examine contextual factors that can shape the manner in which patients may respond to different wait times. We also identify actions providers and clinics can take to promote positive wait experiences and mitigate negative ones. METHODS: We conducted over 130 h of semi-structured interviews with patients new to two HIV primary care clinics in Houston, Texas. We interviewed patients before the first provider visit, again within two weeks of the first visit, and again at 6-12 months. We analyzed the interviews using directed and conventional content analysis. RESULTS: Our study showed that patients' "willingness to wait" is the product of the actual wait time, individual factors, such as the perceived value of the visit and cost of a long wait, and clinic and provider factors. Analyses revealed key steps providers and clinics can take to improve the wait time experience. These include: 1) proactively informing patients of delays, 2) explicitly apologizing for delays, and 3) providing opportunities for diversion. Patients noted the importance of these steps in curtailing frustrations that may result from a long wait. CONCLUSIONS: Our study highlights key steps cited by patients as having the potential to improve the wait time experience. These steps are practical and of particular interest to clinics, where waits are oftentimes inevitable.


Asunto(s)
Instituciones de Atención Ambulatoria/organización & administración , Pacientes/psicología , Listas de Espera , Adulto , Anciano , Femenino , Investigación sobre Servicios de Salud , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pacientes/estadística & datos numéricos , Investigación Cualitativa , Texas
19.
Rev Bras Enferm ; 72(3): 632-639, 2019 Jun 27.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31269126

RESUMEN

OBJECTIVE: To assess the presence and extension of the attribute "Community Orientation" of Primary Health Care from the perspective of health services adult users from the Municipality of Juazeiro do Norte-CE. METHODS: Quantitative, cross-sectional and evaluative study, carried out in 14 Basic Health Units, from October 2016 to June 2017, using the Primary Care Assessment Tool. RESULTS: The attribute assessment was negative, reaching expressive negative responses in the seven districts, with a mean score of 3.8 (±3.8). The Raw Score (RS) reached a mean of 6.6 and the Derived Score (DS) was assigned a score of 6.4, below the cut-off point ≥ 6.60. CONCLUSION: The low value of the DS represents that units are not providers of PHC, suggesting fragility in the integration of services with the community and the need to promote greater discussion among agents, when designing measures of intervention and improvement of scores.


Asunto(s)
Participación de la Comunidad/psicología , Orientación , Pacientes/psicología , Atención Primaria de Salud/normas , Adulto , Brasil , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pacientes/estadística & datos numéricos , Atención Primaria de Salud/métodos , Atención Primaria de Salud/estadística & datos numéricos
20.
Medicina (Kaunas) ; 55(7)2019 Jun 26.
Artículo en Inglés | MEDLINE | ID: mdl-31248007

RESUMEN

Background and Objectives: Oral anticoagulation (OAC) is widely used in daily clinical practice worldwide for various indications. We aimed to explore the perception of Bulgarian clinicians about their patients' attitude and knowledge of long-term OAC, prescribed for atrial fibrillation (AF) and/or known deep venous thrombosis (DVT)/pulmonary embolism (PE). Materials and Methods: We performed a cross-sectional study that involved 226 specialists: 187 (82.7%) cardiologists, 23 (10.2%) neurologists, and 16 (7.1%) vascular surgeons. They filled in a questionnaire, specially designed for our study, answering various questions regarding OAC treatment in their daily clinical practice. Results: The mean prescription rate of OACs in AF patients was 80.3% and in DVT/PE-88.6%. One hundred and eighty-seven (82.7%) of the participants stated they see their patients on OAC at least once per month. According to more than one-third of the inquired clinicians, the patients did not understand well enough the provided information concerning net clinical benefit of OAC treatment. About 68% of the clinicians declared that their patients would prefer a "mutual" approach, discussing with the physician the OAC options and taking together the final decision, whereas according to 43 (19.0%), the patients preferred the physician to take a decision for them. Patients' OAC treatment had been interrupted at least once within the last year due to a physician's decision by 178 (78.8%) of the participants and the most common reason was elective surgery. The most influential factors for a patient's choice of OAC were the need of a specific diet to be kept, intake frequency, and possible adverse reactions. Conclusions: Our results suggest that a clinician's continuous medical education, shared decision-making, and appropriate local strategies for improved awareness of AF/DVT/PE patients are key factors for improvement of OAC management.


Asunto(s)
Anticoagulantes/normas , Alfabetización en Salud/normas , Pacientes/psicología , Percepción , Médicos/psicología , Administración Oral , Adulto , Análisis de Varianza , Anticoagulantes/uso terapéutico , Actitud del Personal de Salud , Bulgaria , Estudios Transversales , Femenino , Alfabetización en Salud/métodos , Humanos , Masculino , Persona de Mediana Edad , Pacientes/estadística & datos numéricos , Médicos/estadística & datos numéricos , Estadísticas no Paramétricas
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