Case management programs for people with complex needs: Towards better engagement of community pharmacies and community-based organisations.

INTRODUCTION: The objectives of this study were 1) to describe how case management programs engaged community pharmacies and community-based organisations in a perspective of integrated care for people with complex needs, and 2) to identify enablers, barriers and potential strategies for this engagement. METHODS: Using a descriptive qualitative design, individual interviews and focus groups with patients, healthcare providers and managers were analysed according to a mixed thematic analysis based on a deductive (Rainbow Model of Integrated Care) and an inductive approach. RESULTS AND DISCUSSION: Participants highlighted the individualized service plan as a significant tool to foster a shared person-focused vision of care, information exchanges and concerted efforts. Openness to collaboration was also considered as an enabler for community stakeholders' engagement. The lack of recognition of community-based organisations by certain providers and the time required to participate in individualized service plans were outlined as barriers to professional integration. Limited opportunities for community stakeholders to be involved in decision-making within case management programs were reported as another constraint to their engagement. Cultural differences between organisations regarding the focus of the intervention (psychosocial vs healthcare needs) and differences in bureaucratic structures and funding mechanisms may negatively affect community stakeholders' engagement. Formal consultation mechanisms and improvement of communication channels between healthcare providers and community stakeholders were suggested as ways to overcome these barriers. CONCLUSION: Efforts to improve care integration in case management programs should be directed toward the recognition of community stakeholders as co-producers of care and co-builders of social policies across the entire care continuum for people with complex needs.

Gulf War Era Veterans' perspectives on research: a qualitative study.

AIMS: Many veterans of the 1990-1991 Gulf War Era (GWE) have experienced poorly understood health issues. In response to challenges recruiting this population for research, we conducted focus groups and semi-structured phone interviews with GWE veterans and subject matter experts (SMEs) to explore GWE veterans' perceptions about research. MAIN METHODS: Transcribed discussions were content-analyzed. Participants discussed research-related motivators and barriers identified among other populations, and nuances that may be specific to GWE veterans. KEY FINDINGS: Examples of motivating factors included: seeking answers about causes of and treatment for health issues; helping oneself; and helping other veterans. Examples of barriers included: distrust and dissatisfaction with federal entities; lack of research follow-through; and concerns about privacy and confidentiality. SIGNIFICANCE: Researchers can use this information to better address GWE veterans' concerns and motivate them to participate in research. Inclusion of GWE veterans in research will allow researchers and clinicians to better understand and address health issues affecting this population.

Application of the community dialogues method to identify ethical values and priorities related to pharmacogenomics.

Given the expansion of genetics in medicine, there is a growing need to develop approaches to engage patients in understanding how genetics affects their health. Various qualitative methods have been applied to gain a deeper understanding of patient perspectives in topics related to genetics. Community dialogues (CD) are a bi-directional research method that invites community members to discuss a pertinent, challenging topic over the course of a multi-week period and the community members openly discuss their positions on the topic. Authors discuss the first application of the CD method to the topic of pharmacogenetics testing. Additional CD are needed to engage diverse participant populations on this topic to improve genetics literacy, enhance physician engagement and drive policy change.

Psycho-social and behavioural impact of COVID 19 on young adults: Qualitative research comprising focused group discussion and in-depth interviews.

A qualitative study comprising eight focus group discussions and two in-depth interviews were conducted to explore the social and behavioural changes in young adults during COVID pandemic. Common themes identified were changes in interpersonal and intrapersonal relationships, changes in health-related behaviour, lifestyle modifications and impact on academic and professional life.

Voices of the vulnerable: Exploring the livelihood strategies, coping mechanisms and their impact on food insecurity, health and access to health care among Syrian refugees in the Beqaa region of Lebanon.

Lebanon has approximately one million Syrian refugees (SR) registered with the United Nations High Commission on Refugees (UNHCR) and an unknown number of unregistered SR, who cannot benefit from formal assistance. This study aimed to examine the livelihoods, coping strategies, and access to healthcare among SR based on registration status and accompanying formal assistance. A mixed-method approach with more emphasis on the qualitative design was adopted. A purposive convenient sampling approach was used to recruit SR from informal tented settlements (ITS) in the Beqaa region in Lebanon. Data collection included 19 focus group discussions (FGDs) that were conducted with participants, who were further divided into three groups: registered refugees with assistance, registered without assistance and unregistered. Twelve in-depth interviews were conducted with key informants from humanitarian organizations. All interviews and FGDs were audio recorded, transcribed, and thematically analyzed. SR were highly dependent on formal assistance when received, albeit being insufficient. Regardless of registration status, refugees resorted to informal livelihood strategies, including informal employment, child labor, early marriage, and accruing debt. Poor living conditions and food insecurity were reported among all SR. Limited healthcare access and high out-of-pocket costs led to limited use of antenatal care services, prioritizing life-threatening conditions, and resorting to alternative sources of healthcare. Severity of these conditions and their adverse health consequences were especially pronounced among unregistered refugees. Our findings shed light on the economic and health disparities among marginalized SR, with the lack of registration and formal assistance increasing their vulnerability. More tailored and sustainable humanitarian programs are needed to target the most vulnerable and hard-to-reach groups.

Tratamiento de la desnutrición relacionada con la enfermedad: situación de la regulación en el Sistema Nacional de Salud. Un estudio exploratorio mediante grupos focales / Treatment of disease-related malnutrition: status of regulation in the Spanish National Health System. An exploratory study through focus groups

ANTECEDENTES Y OBJETIVOS: la normativa que regula la inclusión de alimentos para usos médicos especiales (ADUME) entre las prestaciones del Sistema Nacional de Salud (SNS) fue elaborada hace unos 15 años, si bien la nutrición enteral domiciliaria (NED) se comenzó a regular en 1998. La evolución de las características técnicas de los ADUME justifica un análisis de la actual normativa y la consideración de posibles modificaciones que permitan la incorporación de avances tecnológicos. MATERIAL Y MÉTODOS: reuniones estructuradas siguiendo la metodología del grupo focal, con expertos en su mayoría médicos (91 %), mujeres (55 %) y especialistas hospitalarios en disciplinas relacionadas con la nutrición (73 %) de 8 hospitales y 6 comunidades autónomas. Previamente, los participantes recibieron 4 documentos resumen de diferentes aspectos técnicos de la regulación sobre ADUME en España. Se transcribió de forma anonimizada el audio de las reuniones y se codificó su contenido en 9 códigos: 1) problemática y regulación; 2) beneficios clínicos y evidencia de eficacia o efectividad; 3) indicaciones clínicas; 4) contexto internacional y comparaciones con otros países; 5) impacto presupuestario; 6) coste-efectividad; 7) riesgos y motivos para mantener la regulación actual; 8) propuestas de avance, factibilidad y aspectos que dificultan la implementación; y 9) otros temas. RESULTADOS: los grupos señalaron la necesidad de modificar aspectos regulatorios relacionados con la exclusión de financiación de las fórmulas de densidad calórica superior a 2,1 kcal/ml, la exclusión de la financiación de los ADUME obtenidos total o parcialmente a partir de alimentos ordinarios, la preferencia por la alimentación por sonda y la exclusividad de la financiación de fórmulas completas para los ADUME que se empleen por vía oral como complemento de una ingesta insuficiente. CONCLUSIONES: sobre la base del desarrollo tecnológico y la aplicación clínica de los ADUME en los últimos años, el SNS debería actualizar la regulación de la financiación de estos productos. La mayor parte de estos cambios no implican incremento del gasto si se mantienen las condiciones actuales en cuanto a indicaciones y precios máximos

BACKGROUND AND OBJECTIVES: the legislation currently regulating the inclusion of Food for Special Medical Purposes (FSMP) among the benefits of the National Health System (SNS) was made approximately 15 years ago. The evolution of the technical characteristics of the FSMP justifies an analysis of the current regulation and the consideration of possible regulatory modifications that would allow the incorporation of the progress achieved. MATERIAL AND METHODS: four successive focus groups of experts, mostly doctors (91%), hospital specialists in disciplines related to nutrition (73%), from 8 different hospitals and 6 autonomous communities. Previously, 4 documents summarizing different technical aspects of the regulation on FSMP in Spain were sent to the participants. The audio of the meetings was transcribed anonymously and its content was codified. RESULTS: the contents of the focus groups were grouped into 9 codes: 1) problems and regulation; 2) clinical benefits and evidence of efficacy or effectiveness; 3) clinical indications; 4) international context and comparisons with other countries; 5) budgetary impact; 6) cost-effectiveness; 7) risks and reasons for maintaining current regulation; 8) proposals for progress, feasibility and aspects that make implementation difficult; and 9) other issues. CONCLUSIONS: based on the technological development and clinical application of the FSMP carried out in recent years, an update of the regulation of these products can be proposed for financing by the National Health System in Spain. Most of these changes do not imply an increase in expenditure if current conditions regarding indications and maximum prices are maintained

Experiences with medical cannabis in the treatment of veterans with PTSD: Results from a focus group discussion.

Posttraumatic stress disorder (PTSD) is an often chronic condition for which currently available medications have limited efficacy. Medical cannabis is increasingly used to treat patients with PTSD; however, evidence for the efficacy and safety of cannabinoids is scarce. To learn more about patients' opinions on and experiences with medical cannabis, we organized a focus group discussion among military veterans (N = 7) with chronic PTSD who were treated with medical cannabis. Afterwards, some of their partners (N = 4) joined the group for an evaluation, during which they shared their perspective on their partner's use of medical cannabis. Both sessions were audio-recorded, transcribed verbatim, and analyzed by means of qualitative content analysis. Five overarching themes were identified. The first four themes related to the different phases of medical cannabis use - namely, 1) Consideration; 2) Initiation; 3) Usage; and 4) Discontinuation. The fifth theme related to several general aspects of medical cannabis use. Patients used medical cannabis to manage their symptoms and did not experience an urge to "get high." They used a variety of different cannabis strains and dosages and reported several therapeutic effects, including an increased quality of sleep. Furthermore, discussions about the experienced stigma surrounding cannabis generated insights with implications for the initiation of medical cannabis use. These results underscore the value of qualitative research in this field and are relevant for the design of future clinical trials on the use of medical cannabis for the treatment of PTSD.

Health Care Personnel's Perspective on Potential Electronic Health Interventions to Prevent Hospitalizations for Older Persons Receiving Community Care: Qualitative Study.

BACKGROUND: The use of electronic health (eHealth) interventions is suggested to help monitor and treat degenerative and chronic diseases through the use of sensors, alarms, and reminders and can potentially prevent hospitalizations for home-dwelling older persons receiving community care. It is increasingly recognized that the health care personnel's acceptance of a technological application remains a key challenge in adopting an intervention, thus interventions must be perceived to be useful and fit for purpose by the actual users. OBJECTIVE: The aim of this study was to identify and explore the perspectives of managers and health care personnel in community care regarding the use of eHealth interventions in terms of prevention of hospitalizations for home-dwelling older persons receiving community care. METHODS: A case study with a qualitative approach was carried out in community care in a Norwegian municipality, comprising individual interviews and focus group interviews. A total of 5 individual interviews and 2 focus group interviews (n=12) were undertaken to provide the health care personnel's and managers' perspective regarding the use of eHealth interventions, which could potentially prevent hospitalizations for home-dwelling older persons receiving community care. Data were analyzed by way of systematic text condensation, as described by Malterud. RESULTS: The data analysis of focus group interviews and individual interviews resulted in 2 categories: potential technological applications and potential patient groups. Discussions in the focus groups generated several suggestions and wishes related to technical applications that they could make use of in their day-to-day practice. The health care personnel warranted tools and measures to enhance and document their clinical observations in contact with patients. They also identified patient groups, such as patients with chronic obstructive pulmonary disease or dehydration or urinary tract infections, for whom hospitalizations could potentially have been prevented. CONCLUSIONS: We have shown that the health care personnel in community care warrant various technological applications that have the potential to improve quality of care and resource utilization in the studied municipality. We have identified needs and important matters in practice, which are paramount for acceptance and adoption of an intervention in community care.

Medicine taking behaviours of people with type 2 diabetes in Indonesia: a qualitative study.

Background Medicine-taking behaviour of people in Indonesia is particularly complex because of Indonesia's pluralistic health system, in which public and private medical services co-exist with traditional and alternative treatments. Objective This study aimed to explore medicine-taking behaviours of people with type 2 diabetes in Indonesia. Setting Rural and urban communities in East Nusa Tenggara and West Sumatera Provinces. Method Qualitative study with focus group discussions. Six focus groups, involving 45 diabetes patients, were conducted. The discussions were recorded and transcribed verbatim in the original language. The transcripts were translated into English and analysed for common themes. Main outcome measure People's medicine-taking behaviours after being diagnosed with diabetes. Results Medicine-taking behaviours of diabetes participants aligned with the concept of resistance to medicine taking and a therapeutic decision model. It varied based on individual lay evaluation processes. After being diagnosed, participants commonly took the prescribed medicines for some period. They then self-evaluated the effectiveness of the prescribed medicines. Based on the self-evaluation, patients either continued to take the prescribed medicines or made a variety of changes: they discontinued taking the prescribed medicines, combined or alternated prescribed medicines with traditional medicines, or occasionally took medicines they bought without prescription. Reasons mentioned by participants for choosing traditional medicines including perceived ineffectiveness or side effect of the prescribed-medicines. Long-term medicine taking burdened the participants as the notion of being fed up with taking medicines was frequently mentioned. Problems of inaccessibility of the prescribed-medicines also emerged. Conclusion Diabetes patients' medicine-taking behaviours and their reasons for decision-making need to be acknowledged to improve adherence to medicine. Health professionals should assist patients on how to evaluate effectiveness, manage side effects, and reduce the medicine-related burden.

The International Spinal Cord Injury Pediatric Activity and Participation Basic Data Set.

Study design: International focus groups. Objectives: The objective of this project was to develop the International Spinal Cord Injury (SCI) Pediatric Activity and Participation (A&P) Basic Data Set. Methods: A focus group of experts in pediatric and adult SCI, and contributors of the existing adult International SCI Adult A&P Basic Data Set convened to develop an initial draft of the data set, which was iteratively refined over a 12 month period based on relevant literature and existing outcome measures that evaluate pediatric activity and participation. The draft was reviewed and approved by the larger project working group and then distributed to the International Spinal Cord Society (ISCoS), American Spinal Injury Association (ASIA), and relevant expert groups for review. Feedback received was considered before the final data set was approved. Results: The International SCI Pediatric A&P Basic Data Set is comprised of 13 variables: administration date, mobility, dressing, feeding, toileting, communication, family outings, spending time with friends, being out with friends, participating in team or club activity, paid work, dating, and physical activity. It is intended for children between 6 and 17 years of age, who have been discharged from initial rehabilitation/hospitalization for a minimum of 3 months. Conclusion: The International SCI Pediatric A&P Basic Data Set was developed to standardize the recording of a minimal amount of information about activities and participation in children with SCI. Further work on reliability and cultural validation is needed. Sponsorship: This study was funded by the Rick Hansen Institute, Research Award #G2015-27 (Mulcahey, PI).

Impact of a community-based intervention on Latino grandparents' knowledge about and self-efficacy in supporting grandchildren's physical activities.

INTRODUCTION: Latino grandparents are often involved in rearing grandchildren, but their roles in promoting children's physical activity (PA) have been largely overlooked. This study examined the impact of a community-based intervention called Nietos Activos y Saludables (Active and Healthy Grandchildren) on Latino grandparents' knowledge about and self-efficacy in supporting grandchildren's (aged 2-12 years) PA. METHOD: The Spanish language intervention, consisting of 4 weekly sessions, was delivered to 12 Latino grandparents (primarily female, aged > 60 years) in Los Angeles County from October to November 2017. Pre- and posttest surveys and postintervention focus groups assessed the intervention impact. RESULTS: Participants indicated that the intervention provided useful information. After intervention sessions, participants achieved a higher score in test on PA requirements for children. They also reported greater knowledge about children's PA, local resources for children's PA, and modifying children's behavior. Additionally, participants reported greater confidence in motivating children in PA and collaborating with parents in promoting children's PA. Results of focus groups generally confirmed the quantitative findings. DISCUSSION: Nietos Activos y Saludables intervention has the promise to increase Latino grandparents' knowledge about and self-efficacy in supporting grandchildren's PA. Future studies should test the impact of the intervention on grandparents' behavior and grandchildren's health outcomes using a randomized controlled trial. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Continuity of care for TB patients at a South African hospital: A qualitative participatory study of the experiences of hospital staff.

BACKGROUND: Ensuring effective clinical management and continuity of TB care across hospital and primary health-care services remains challenging in South Africa. The high burden of TB, coupled with numerous health system problems, influence the TB care delivered by hospital staff. OBJECTIVE: To understand factors from the perspectives of hospital staff that influence the clinical management and discharge of TB patients, and to elicit recommendations to improve continuity of care for TB patients. DESIGN: Participatory action research was used to engage hospital staff working with TB patients admitted to a central public hospital in the Western Cape province, South Africa. Data were collected through eight focus group discussions with nurses, junior doctors and ward administrators. Data analysis was done using Miles and Huberman's framework to identify emerging patterns and to develop categories with themes and sub-themes. The participants influenced all phases of the research process to inform better practices in TB clinical management and discharge planning at the hospital. RESULTS: The emerging themes and sub-themes were categorized into two overall sections: The clinical care management process and the discharge and referral process. Nurses expressed a fear of exposure to TB and MDR-TB due to challenges in clinical and infection-prevention control. Clinical hierarchies, poor interdisciplinary teamwork, limited task shifting and poor communication interfered with effective clinical and discharge processes. A high workload, staff shortages and inadequate skills resulted in insufficient information and health education for TB patients and their caregivers. Despite awareness of the patients' socio-economic challenges, some aspects of care were not patient-centered, and caregivers were not included in discharge planning. Communication between the hospital and referral points was inefficient and poorly supported by information systems. Hospital staff recommended improved infection prevention and control practices and interdisciplinary teamwork in the hospital, that TB education for patients be integrated with hospital staff functions, with more patient-centered discharge planning, and improved communication across hospitals and primary health care levels. CONCLUSIONS: Interdisciplinary teamwork, more patient-centered care, and better communication within the hospital and with primary health-care services are needed for improved continuity of care for TB patients. Further studies on factors contributing to, and interventions to improve, continuity of TB care in similar hospital settings are needed.

Was it worth it? Older adults' experiences of participating in a population-based cohort study - a focus group study.

BACKGROUND: At present, we know relatively little about priorities and problems with topics that older adults experience when completing different examinations in longitudinal population-based studies. To examine these topics, research must be adapted to investigate the meanings, motivations, and interpretations of the individual participants themselves. Therefore, the present study aimed to explore older adults' motives, understandings and experiences regarding participating in the Gothenburg H70 Birth Cohort Studies (the H-70 study). METHODS: Focus group discussions were used. A total of thirty-eight persons, 19 women and 19 men participated in nine focus groups. A strategic sampling technique was used to ensure that the focus group participants represented the larger population. RESULTS: The results supported the overall theme: "It was well worth the effort," which summarized how the participants felt about the population health study. The following specific themes were also identified: an intense event, for the benefit of oneself and others, confidence in health research and the researcher, key decisions about test outcomes and the survey raising questions and providing few answers. CONCLUSIONS: Knowledge of priorities and problems with topics experienced by older adults completing different examinations when participating in longitudinal population-based studies is crucial for research to improve the health and wellbeing of older people. To date, older people's involvement in population-based cohort studies has largely been as research subjects. This study is a first step toward the participants taking a more active part by allowing them to share their experiences which can be used to improve the research procedures. This requires the participation of older adults in collaboration with the researchers, to ensure the quality of longitudinal studies of older adults. Therefore, our intention when it comes to future research will be to involve older adults-the target group-in the research procedure.

Conclusiones del I Foro Nacional de jefes de Estudio, técnicos docentes y responsables autonómicos de Formación Sanitaria Especializada y del II Congreso Nacional de Formación Sanitaria Especializada (XIV Encuentro Nacional de tutores y jefes de Estudio). SEFSE-AREDA 2017, Madrid 28-29 de septiembre / Conclusions of I National Forum of heads, technicians and regional responsibles of Specialized Training and of the 2th National Congress of the Spanish Society for Postgraduate Medical Education (14th National Meeting of Heads and Tutors of Specialized Training). SEFSE-AREDA 2017, Madrid, September 28-29

Una buena gestión y calidad de la Formación Sanitaria Especializada (FSE) exige el compromiso explícito de los responsables de las CCAA y de los centros sanitarios. Esto implica la acreditación y reconocimiento de tutores, desarrollar el marco normativo que establece el RD 183/2008 (a los nueve años de su publicación sólo Cataluña, Canarias, Castilla y León, Extremadura, La Rioja y el País Vasco, lo han hecho), una mención explícita de la FSE en los planes estratégicos de las organizaciones sanitarias y en los contratos-programa con las unidades docentes y una participación activa de los jefes de estudio en los consejos de dirección de los centros. Por parte del Ministerio de Sanidad, es preciso agilizar la acreditación de las nuevas unidades docentes y abordar, junto con las CCAA, los problemas de financiación del proyecto de troncalidad y la organización de las unidades docentes troncales. Respecto al sentido de la formación, esta se ha de centrar en la seguridad del paciente, aquí la simulación es una metodología formativa idónea, y en la humanización, con una práctica de la medicina bajo un modelo deliberativo, siendo los formadores ejemplo para los que aprenden

The commitment of the heads of the Autonomous Communities and the health centers is key to a good management and the quality of the Specialized Healthcare Training (SHT). This implies the accreditation and recognition of tutors, developing the regulatory framework established by Royal Decree 183/2008 (nine years after its publication, only Catalonia, the Canary Islands, Castilla y León, Extremadura, La Rioja and the Basque Country have done so), an explicit mention of the SHT in the strategic plans of the health organizations and an active participation of the heads of SHT in the boards of directors. On the part of the Ministry of Health, it is necessary to speed up the accreditation process of new teaching units and, together with the Autonomous Communities, and address the financing problems of the core curriculum project and the organization of the core teaching units. Regarding the sense of training, this has to focus on safety patient, here the simulation is a suitable training methodology, and in the humanization, with a practice of medicine under a deliberative model, being the trainers an example for those who learn

WASP (Write a Scientific Paper): Collecting qualitative data using focus groups.

Qualitative data is important to understand certain phenomena. While quantitative data is important to understand the prevalence of attitudes and behaviour in psychosocial medical research, qualitative data can help understand and explain the reasons behind attitudes behaviour. One of the methods of collecting qualitative data is the focus group discussion. During a focus group researchers facilitate a discussion to elicit views and lay theories about the research topic. Researchers use group facilitation skills in order to make participants feel at ease and disclose their thoughts, feelings and perceptions about a particular issue with the least bias possible. This paper discusses how the text obtained after transcribing the discussions can be analysed using thematic analysis.

Computer-Mediated Communication to Facilitate Synchronous Online Focus Group Discussions: Feasibility Study for Qualitative HIV Research Among Transgender Women Across the United States.

BACKGROUND: Novel, technology-based methods are rapidly increasing in popularity across multiple facets of quantitative research. Qualitative research, however, has been slower to integrate technology into research methodology. One method, computer-mediated communication (CMC), has been utilized to a limited extent for focus group discussions. OBJECTIVE: This study aimed to assess feasibility of an online video conferencing system to further adapt CMC to facilitate synchronous focus group discussions among transgender women living in six cities in eastern and southern United States. METHODS: Between August 2017 and January 2018, focus group discussions with adult transgender women were conducted in English and Spanish by research teams based in Boston, MA, and Baltimore, MD. Participants were sampled from six cities: Baltimore, MD; Boston, MA; New York, NY; Washington, DC; Atlanta, GA; and Miami, FL. This was formative research to inform a technology-enhanced cohort study to assess HIV acquisition among transgender women. This analysis focused on the methodologic use of CMC focus groups conducted synchronously using online software that enabled video or phone discussion. Findings were based on qualitative observations of attendance and study team debriefing on topics of individual, social, technical, and logistical challenges encountered. RESULTS: A total of 41 transgender women from all six cities participated in seven online focus group discussions-five English and two Spanish. There was equal racial distribution of black/African American (14/41, 34%) and white (14/41, 34%) attendees, with 29% (12/41) identifying as Hispanic/Latina ethnicity. Overall, 29 of 70 (41%) eligible and scheduled transgender women failed to attend the focus group discussions. The most common reason for nonattendance was forgetting or having a scheduling conflict (16/29, 55%). A total of 14% (4/29) reported technical challenges associated with accessing the CMC focus group discussion. CMC focus group discussions were found to facilitate geographic diversity; allow participants to control anonymity and privacy (eg, use of pseudonyms and option to use video); ease scheduling by eliminating challenges related to travel to a data collection site; and offer flexibility to join via a variety of devices. Challenges encountered were related to overlapping conversations; variable audio quality in cases where Internet or cellular connection was poor; and distribution of incentives (eg, cash versus gift cards). As with all focus group discussions, establishment of ground rules and employing both a skilled facilitator and a notetaker who could troubleshoot technology issues were critical to the success of CMC focus group discussions. CONCLUSIONS: Synchronous CMC focus group discussions provide a secure opportunity to convene participants across geographic space with minimal time burden and without losing the standardized approach that is expected of focus group discussions. This method may provide an optimal alternative to engaging hard-to-reach participants in focus group discussions. Participants with limited technological literacy or inconsistent access to a phone and/or cellular data or service, as well as circumstances necessitating immediate cash incentives may, however, require additional support and accommodation when participating in CMC focus group discussions.

Patients' and Providers' Views on Causes and Consequences of Healthcare Fragmentation in the Ambulatory Setting: a Qualitative Study.

BACKGROUND: Patients with chronic conditions routinely see multiple outpatient providers, who may or may not communicate with each other. Gaps in information across providers caring for the same patient can lead to harm for patients. However, the exact causes and consequences of healthcare fragmentation are not understood well enough to design interventions to address them. OBJECTIVE: We sought to elicit patients' and providers' views on the causes and consequences of healthcare fragmentation. DESIGN AND PARTICIPANTS: We conducted a qualitative study with focus groups of patients and, separately, of providers (attending physicians and nurse practitioners) at an academic hospital-based primary care practice in New York City in June-August 2017. Patient participants were English-speaking adults with ≥ 2 chronic conditions. APPROACH: Each focus group lasted 1 h and asked the same two questions: "Why do you think some patients receive care from many different providers and others do not?" and "What do you think happens as a result of patients receiving care from many different providers?" Data collection continued until a point of data saturation was reached. Thematic analysis was used to identify themes and subthemes. KEY RESULTS: We conducted 6 focus groups with a total of 46 participants (25 patients and 21 providers). Study participants identified 41 unique causes of fragmentation, which originate from 4 different levels of the healthcare system (patient, provider, healthcare organization, and healthcare environment); most causes were not related to medical need. Participants also identified 24 unique consequences of fragmentation, of which 3 were desirable and 21 were undesirable. CONCLUSIONS: The results of this study offer a granular roadmap for how to decrease healthcare fragmentation. The large number and severity of negative consequences (including medical errors, misdiagnosis, increased cost, and provider burnout) underscore the urgent need for interventions to address this problem directly.

Perspectives of Rheumatoid Arthritis Patients on Electronic Communication and Patient-Reported Outcome Data Collection: A Qualitative Study.

OBJECTIVE: To identify the perspectives of patients with rheumatoid arthritis (RA) on electronic recording of between-visit disease activity and other patient-reported outcomes (PROs) and on sharing this information with health care providers or peers. METHODS: Patients with RA were recruited to participate in focus groups from December 2014 to April 2015. The topic guide and analysis were based on the Andersen-Newman framework. Sessions were audiorecorded, transcribed, independently coded, and analyzed for themes. RESULTS: Thirty-one patients participated in 7 focus groups. Their mean ± SD age was 51 ± 13.1 years, 94% were women, 52% were African American, 11% were Hispanic, and 37% were white. Three themes emerged: provider communication, information-seeking about RA, and social and peer support. Participants expressed a willingness to track disease activity data to share with health care providers electronically if providers would act on the information. Participants envisioned symptom tracking and information sharing as a mechanism to relay and obtain reliable information about RA. Participants were also interested in electronic communication between visits if it facilitated learning about symptom management and enhanced opportunities for social support among patients with RA. CONCLUSION: Patients with RA may be amenable to electronic collection and sharing of PRO-type data between clinical encounters if it facilitates communication with health care providers and provides access to reliable information about RA. Providing patients with social support was important for enhancing PROs collection by helping them overcome barriers by using electronic devices and overcome reservations about the value of these data.

What Patients Know About Services to Help Manage Chronic Diseases and Medications: Findings from Focus Groups on Medication Therapy Management.

BACKGROUND: Managing and treating patients with multiple chronic conditions presents challenges on many levels. Pharmacist-delivered medication therapy management (MTM) services, mandated as part of the Medicare Part D drug benefit, are designed to help patients manage their chronic conditions and medications. OBJECTIVE: To identify factors that influence patient understanding and use of MTM services and potential strategies to educate individuals about MTM. METHODS: Participants who had at least 2 chronic conditions, were taking 2 or more prescription medications, and were aged 18 years or older were recruited from community-based settings to participate in focus groups. The focus groups aimed to identify participants' perceptions and use of MTM services, barriers and facilitators to utilization, and medication problems. Participants were asked to complete a 14-item health care questionnaire and view a brief, 3-minute video introducing the topic of MTM before the group discussion. The health care questionnaire data were analyzed in Microsoft Excel. The focus group responses were transcribed and entered into the computer program ATLAS.ti for thematic analysis. Two independent reviewers qualitatively coded the discussion question responses; a third reviewer investigated discrepancies and facilitated consensus among the reviewers. RESULTS: Participants (N = 27) were mostly female (70.4%), college educated (62.9%), and had Medicare insurance (81.5%). Seven themes were identified: (1) new proposed names for MTM, (2) mechanisms to gain interest in and to promote the value of MTM, (3) familiarity with MTM, (4) pharmacists' training and expertise in MTM, (5) experience with MTM, (6) reasons for nonparticipation in MTM, and (7) preferred method to learn about MTM. Participants did not understand the term "medication therapy management" and felt the interpretation of "therapy"' differed between health care professionals and the public. Some participants used MTM services to learn about appropriate use of their medications, while others were unsure about their eligibility, associated costs, and how to access the services. Participants had limited pharmaceutical knowledge but felt pharmacist-provided MTM services were helpful. Participants were unfamiliar with pharmacists' skills and training. Participants' experiences with MTM services ranged from disregarding the invitation to participate to having pharmacists identify drug-drug interactions. Reasons for nonparticipation in MTM services included being unaware of their eligibility, failing to read excessive information from insurance companies, and being uncertain of the identity of the telephone caller. Preferred methods for learning more about MTM services included the Internet, e-mail, information availability at physician's office, and television advertisements. CONCLUSIONS: These results suggest that the lay public remains largely unaware of MTM services and that the term "MTM" is not well understood. Clearly, tailored public health campaigns and patient engagement strategies are needed to promote MTM in chronic disease management, pharmacists as respected providers, and the importance of the prescriber-MTM pharmacist collaborative relationship in managing medications for patients with multiple chronic conditions. DISCLOSURES: Grant funding from SinfoniaRx to Taylor, Axon, Campbell, Fair, and Warholak was used to help conduct this project. Boesen is employed by SinfoniaRx. The other authors have nothing to disclose. This original research was presented as a poster at the Academy of Managed Care Pharmacy 27th Annual Meeting and Expo; April 7-10, 2015; San Diego, CA.

Developing an emotional coping skills workbook for inpatient psychiatric settings: a focus group investigation.

BACKGROUND: Evidence suggests an unmet need for provision of psychological interventions in inpatient psychiatric settings. However, inpatient wards can present a challenging environment in which to implement interventions. The authors developed the Emotional Coping Skills workbook, a psychosocial intervention designed to overcome these challenges and provide inpatients with an opportunity for psychologically-informed therapeutic engagement. The workbook includes information and exercises to empower inpatients to understand their emotions and learn to cope with their distress. METHODS: A qualitative study using thematic analysis was undertaken in two UK inpatient psychiatric hospitals to explore staff's views about whether and how the workbook could be implemented, and on barriers to its use. Thirty-five nursing and occupational therapy staff members participated in four focus groups, and a further two psychologists in semi-structured interviews. RESULTS: Staff identified key barriers to successful implementation of the workbook. These were firstly, the difficulty in finding time and space for therapeutic work in the stressful ward environment. Secondly, staff identified a culture of emotional neglect whereby neither staff nor inpatients felt able to talk about emotions, and patients' physical needs and medication were prioritised. Thirdly, staff discussed how psychotic symptoms and emotional distress could limit patients' ability to engage with the workbook material. Staff suggested ways in which the feasibility of using the workbook could be enhanced. Firstly, they discussed the importance of encouraging staff to value psychological approaches and to view the workbook as a resource to help them manage their existing tasks. Secondly, they emphasised the value of staff drawing on their expertise to deliver the workbook flexibly in different formats and settings, depending on each patient's particular presentation. Thirdly, they advocated empowering staff to decide the timing of intervention delivery in the context of each inpatient's fluctuations in distress and progress towards recovery. CONCLUSIONS: The study has highlighted key principles for flexible and well-integrated intervention delivery; these principles will be helpful for enhancing the feasibility of any nurse-delivered psychological intervention in inpatient settings.