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OBJECTIVE: To understand how the COVID-19 pandemic has impacted sexual and reproductive health (SRH) visits. DESIGN: An ecological study comparing SRH services volume in different countries before and after the onset of the COVID-19 pandemic. SETTING: Seven countries from the INTernational ConsoRtium of Primary Care BIg Data Researchers (INTRePID) across four continents. POPULATION: Over 3.8 million SRH visits to primary care physicians in Australia, China, Canada, Norway, Singapore, Sweden and the USA. METHODS: Difference in average SRH monthly visits before and during the pandemic, with negative binomial regression modelling to compare predicted and observed number of visits during the pandemic for SRH visits. MAIN OUTCOME MEASURES: Monthly number of visits to primary care physicians from 2018 to 2021. RESULTS: During the pandemic, the average volume of monthly SRH visits increased in Canada (15.6%, 99% CI 8.1-23.0%) where virtual care was pronounced. China, Singapore, Sweden and the USA experienced a decline (-56.5%, 99% CI -74.5 to -38.5%; -22.7%, 99% CI -38.8 to -6.5%; -19.4%, 99% CI -28.3 to -10.6%; and -22.7%, 99% CI -38.8 to -6.5%, respectively); while Australia and Norway showed insignificant changes (6.5%, 99% CI -0.7 to -13.8% and 1.7%, 99% CI -6.4 to -9.8%). The countries that maintained (Australia, Norway) or surpassed (Canada) pre-pandemic visit rates had the greatest use of virtual care. CONCLUSIONS: In-person SRH visits to primary care decreased during the pandemic. Virtual care seemed to counterbalance that decline. Although cervical cancer screening appeared insensitive to virtual care, strategies such as incorporating self-collected samples for HPV testing may provide a solution in a future pandemic.
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COVID-19 , Serviços de Saúde Reprodutiva , Neoplasias do Colo do Útero , Humanos , Feminino , Pandemias , Detecção Precoce de Câncer , COVID-19/epidemiologia , Saúde Reprodutiva , Atenção Primária à SaúdeRESUMO
ChatGPT (OpenAI) is an advanced natural language processing tool with growing applications across various disciplines in medical research. Thematic analysis, a qualitative research method to identify and interpret patterns in data, is one application that stands to benefit from this technology. This viewpoint explores the use of ChatGPT in three core phases of thematic analysis within a medical context: (1) direct coding of transcripts, (2) generating themes from a predefined list of codes, and (3) preprocessing quotes for manuscript inclusion. Additionally, we explore the potential of ChatGPT to generate interview transcripts, which may be used for training purposes. We assess the strengths and limitations of using ChatGPT in these roles, highlighting areas where human intervention remains necessary. Overall, we argue that ChatGPT can function as a valuable tool during analysis, enhancing the efficiency of the thematic analysis and offering additional insights into the qualitative data. While ChatGPT may not adequately capture the full context of each participant, it can serve as an additional member of the analysis team, contributing to researcher triangulation through knowledge building and sensemaking.
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Processamento de Linguagem Natural , Humanos , Pesquisa QualitativaRESUMO
BACKGROUND: Type 2 diabetes (T2D) remains an important chronic condition worldwide requiring integrated patient-centred care as advocated by the Chronic Care Model (CCM). The Primary Care Networks (PCNs) in Singapore organise general practitioners (GPs) with nurses and care coordinators to deliver team-based care for patients with chronic conditions. This study examined the quality of care in the PCNs as defined by the CCM from the patients' perspective. METHODS: This study followed a cross-sectional convergent mixed-method design with T2D patients across three PCN types (GP-led, Group, and Cluster). The Patient Assessment of Chronic Illness Care (PACIC, range 1-5) was completed by a convenience sample of 343 patients. Multivariate linear regression was performed to estimate the associations between patient and service characteristics and PACIC summary score. Twenty-four participants were purposively recruited for interviews on the experienced care until thematic saturation was reached. Quantitative and qualitative data were collected concurrently and independently. Integration occurred during study design and data analysis using the CCM as guidance. Quantitative and qualitative results were compared side-by-side in a joint comparison table to develop key concepts supported by themes, subthemes, and patients' quotes. RESULTS: The PACIC mean summary score of 3.21 for 343 patients evidenced that some have received CCM consistent care in the PCNs. Being younger and spending more time with the GP were associated with higher PACIC summary scores. PACIC summary scores did not differ across PCN types. The 24 patients interviewed in the qualitative study reported receiving team-based care, nurse services, good continuity of care, as well as patient-centred care, convenient access, and affordable care. Key concepts showed that integrated care consistent with the CCM was sometimes received by patients in the PCNs. Patient activation, delivery system design/decision support, goal setting/tailoring, and problem-solving/contextual counselling were sometimes received by patients, while follow-up/coordination was generally not received. CONCLUSIONS: Patients with T2D from the Singapore Primary Care Networks received integrated care consistent with the Chronic Care Model, particularly in patient activation, delivery system design/decision support, goal setting/tailoring, and problem-solving/contextual counselling. Follow-up/coordination needed improvement to ensure higher quality of diabetes care.
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Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/terapia , Inquéritos e Questionários , Estudos Transversais , Singapura , Assistência Centrada no Paciente , Doença CrônicaRESUMO
BACKGROUND: Mothers experience a wide range of maternal health problems after childbirth, which in turn, affect their well-being and ability to care for their newborn. These problems may be influenced by factors such as mode of delivery or socio-economic status. OBJECTIVE: This study aims to investigate the prevalence of common maternal health problems and their correlates in a public primary healthcare institution in Singapore. DESIGN: This was a cross-sectional study, based on a self-administered questionnaire. METHODS: A total of 373 mothers (mean age 31.9 years) who accompanied their infants for their 4- to 8-week development assessments at a public primary care clinic in Singapore completed a self-administered questionnaire from June 2021 to December 2021. The questionnaire assessed demographic factors, mode of delivery, number of children, number of individuals providing significant help, and the frequency of common physical and mental maternal health problems using a 5-point Likert-type scale. RESULTS: The five most common maternal health problems were fatigue (77.7%), lower back pain (59.3%), Caesarean wound pain (54.3%), upper back pain (53.0%) and vaginal pain (41.2%). The prevalence of depression and anxiety was 22.0% and 11.3%, respectively. With respect to the symptoms' correlates, pain on passing urine was more frequent after assisted vaginal deliveries than all other forms of deliveries (all pairwise p < 0.01), and pain on passing motion was more frequent in vaginal deliveries than in Caesarean deliveries (all pairwise p < 0.05). Mothers having a larger number of children more frequently experienced headaches (ß = 0.17, SE = 0.05, p = 0.002) and less frequently experienced breastfeeding difficulties (ß = -0.28, SE = 0.08, p < 0.001). CONCLUSION: Mothers experienced a high prevalence of maternal health problems in multiple domains during the first 8 weeks after childbirth. Mode of delivery and number of children were associated with increased prevalence of certain problems. Mothers' physical and mental well-being should be investigated early after delivery and addressed with adequate treatments and resources.
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Saúde Materna , Mães , Gravidez , Feminino , Recém-Nascido , Criança , Humanos , Adulto , Estudos Transversais , Período Pós-Parto , DorRESUMO
OBJECTIVE: Patients with type 2 diabetes require patient-centred care as guided by the Chronic Care Model (CCM). Many diabetes patients in Singapore are managed by the Primary Care Networks (PCNs) which organised healthcare professionals (HCPs) comprising general practitioners, nurses and care coordinators into teams to provide diabetes care. Little is known about how the PCNs deliver care to people with type 2 diabetes. This study evaluated the consistency of diabetes care delivery in the PCNs with the CCM. DESIGN: This was a mixed-method study. The Assessment of Chronic Illness Care (ACIC version 3.5) survey was self-administered by the HCPs in the quantitative study (ACIC scores range 0-11, the latter indicating care delivery most consistent with CCM). Descriptive statistics were obtained, and linear mixed-effects regression model was used to test for association between independent variables and ACIC total scores. The qualitative study comprised semi-structured focus group discussions and used thematic analysis. SETTING: The study was conducted on virtual platforms involving the PCNs. PARTICIPANTS: 179 HCPs for quantitative study and 65 HCPs for qualitative study. RESULTS: Integrated analysis of quantitative and qualitative results found that there was support for diabetes care consistent with the CCM in the PCNs. The mean ACIC total score was 5.62 (SD 1.93). The mean element scores ranged from 6.69 (SD 2.18) (Health System Organisation) to 4.91 (SD 2.37) (Community Linkages). The qualitative themes described how the PCNs provided much needed diabetes services, their characteristics such as continuity of care, patient-centred care; collaborating with community partners, financial aspects of care, enablers for and challenges in performing care, and areas for enhancement. CONCLUSION: This mixed-methods study informs that diabetes care delivery in the Singapore PCNs is consistent with the CCM. Future research should consider using independent observers in the quantitative study and collecting objective data such as patient outcomes.
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Diabetes Mellitus Tipo 2 , Grupos Focais , Assistência Centrada no Paciente , Atenção Primária à Saúde , Humanos , Diabetes Mellitus Tipo 2/terapia , Singapura , Atenção Primária à Saúde/organização & administração , Assistência Centrada no Paciente/organização & administração , Masculino , Feminino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto , Inquéritos e Questionários , Prestação Integrada de Cuidados de Saúde/organização & administraçãoRESUMO
BACKGROUND: The COVID-19 pandemic has reshaped healthcare delivery worldwide. OBJECTIVE: To explore potential changes in the reasons for visits and modality of care in primary care settings through the International Consortium of Primary Care Big Data Researchers (INTRePID). METHODS: We conducted a cross-sectional, retrospective study from 2018-2021. We examined visit volume, modality, and reasons for visits to primary care in Argentina, Australia, Canada, China, Peru, Norway, Singapore, Sweden, and the USA. The analysis involved a comparison between the pre-pandemic and pandemic periods. RESULTS: There were more than 215 million visits from over 38 million patients during the study period in INTRePID primary care settings. Most INTRePID countries experienced a decline in monthly visit rates during the first year of the pandemic, with rate ratios (RR) and 95% confidence intervals (CI) ranging from RR:0.57 (95%CI:0.49-0.66) to RR:0.90 (95%CI:0.83-0.98), except for in Canada (RR:0.99, 95%CI:0.94-1.05) and Norway (RR:1.00, 95%CI:0.92-1.10), where rates remained stable and in Australia where rates increased (RR:1.19, 95%CI:1.11-1.28). Argentina, China, and Singapore had limited or no adoption of virtual care, whereas the remaining INTRePID countries varied in the extent of virtual care utilization. In Peru, virtual visits accounted for 7.34% (95%CI:7.33%-7.35%) of all interactions in the initial year of the pandemic, dipping to 5.22% (95%CI:5.21%-5.23%) in the subsequent year. However, in Canada 75.30% (95%CI:75.20%-75.40%) of the visits in the first year were virtual, decreasing to 62.77% (95%CI:62.66%-62.88%) in the second year. Diabetes, hypertension and/or hyperlipidemia and general health exams were in the top 10 reasons for visits in 2019 for all countries. Anxiety, depression and/or other mental health related reasons were among the top 10 reasons for virtual visits in all countries that had virtual care. CONCLUSIONS: The pandemic resulted in changes in reasons for visits to primary care, with virtual care mitigating visit volume disruptions in many countries.
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Background: The COVID-19 pandemic impacted mental health disorders, affecting both individuals with pre-existing conditions and those with no prior history. However, there is limited evidence regarding the pandemic's impact on mental health visits to primary care physicians. The International Consortium of Primary Care Big Data Researchers (INTRePID) explored primary care visit trends related to mental health conditions in Argentina, Australia, Canada, China, Norway, Peru, Singapore, Sweden, and the USA. Methods: We conducted an interrupted time series analysis in nine countries to examine changes in rates of monthly mental health visits to primary care settings from January 1st, 2018, to December 31st, 2021. Sub-group analysis considered service type (in-person/virtual) and six categories of mental health conditions (anxiety/depression, bipolar/schizophrenia/other psychotic disorders, sleep disorders, dementia, ADHD/eating disorders, and substance use disorder). Findings: Mental health visit rates increased after the onset of the pandemic in most countries. In Argentina, Canada, China, Norway, Peru, and Singapore, this increase was immediate ranged from an incidence rate ratio of 1·118 [95% CI 1.053-1.187] to 2.240 [95% CI 2.057-2.439] when comparing the first month of pandemic with the pre-pandemic trend. Increases in the following months varied across countries. Anxiety/depression was the leading reason for mental health visits in most countries. Virtual visits were reported in Australia, Canada, Norway, Peru, Sweden, and the USA, accounting for up to 40% of the total mental health visits. Interpretation: Findings suggest an overall increase in mental health visits, driven largely by anxiety/depression. During the COVID-19 pandemic, many of the studied countries adopted virtual care in particular for mental health visits. Primary care plays a crucial role in addressing mental ill-health in times of crisis. Funding: Canadian Institutes of Health Research grant #173094 and the Rathlyn Foundation Primary Care EMR Research and Discovery Fund.
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OBJECTIVES: To explore the perspectives of primary care physicians with regard to the barriers and facilitators towards optimising statin therapy in patients with hyperlipidaemia in the very high-risk group. DESIGN: Qualitative descriptive study. SETTING: Four polyclinics in a public primary care institution in Singapore. PARTICIPANTS: Seven men and five women working as primary care physicians were recruited for in-depth interviews. RESULTS: The major barriers to statin optimisation identified were patients' lack of knowledge and awareness, patients' fear of side effects, negative external influences on patients, poor doctor-patient relationship, time constraint during consultations, physicians' unfamiliarity with guidelines, low health literacy among the local population and lack of strong national policy. The major facilitators identified were patient education, providing continuity of care, improving electronic medical record systems' capabilities, physician education and public education. CONCLUSION: We identified several important barriers and facilitators of statin therapy optimisation in this study. This information offers insights into the development of a multipronged approach to address barriers across different levels with the aim of optimising statin use, reducing cardiovascular events and improving patient outcomes.
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Inibidores de Hidroximetilglutaril-CoA Redutases , Hiperlipidemias , Médicos de Atenção Primária , Masculino , Humanos , Feminino , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hiperlipidemias/tratamento farmacológico , Singapura , Relações Médico-PacienteRESUMO
Background: Health literacy and illness perception play crucial roles in tackling the cardiometabolic disease epidemic. We aim to compare the attitudes, knowledge, self-perceived risks and actions taken, between individuals with and without metabolic risk factors (MFs). Methods: From 5 June to 5 October 2022, participants of the general public were invited to complete a self-administered questionnaire. MF status was defined as the presence of hypertension, hyperlipidemia, diabetes mellitus and/or current/previous smoking. Participants were assessed based on four categories (knowledge-based, attitude-based, perceived risk, and action-based) of questions pertaining to four cardiometabolic diseases - diabetes mellitus, hypertension, hyperlipidemia, and non-alcoholic fatty liver disease. Results: A total of 345 participants were enrolled, of whom 34.5% had at least one MF. Compared to those without MFs, participants with MFs had lower knowledge scores, but higher perceived risk scores across all cardiometabolic diseases. The largest knowledge gap pertained to hypertension-related questions. After adjustment, linear regression demonstrated that the presence of MFs (ß:2.752, 95%CI: 0.772-4.733, p = 0.007) and higher knowledge scores (ß:0.418, 95%CI: 0.236-0.600, p < 0.001) were associated with higher perceived risk. Despite increased perceived risk in those with MFs, this translated to only few increased self-reported preventive actions, when compared to those without MFs, namely the reduction in red meat/processed food consumption (p = 0.045) and increase in fruits/vegetables consumption (p = 0.009). Conclusion: This study identified a vulnerable subpopulation living with MFs, with high perceived risks, and discordant levels of knowledge and preventive actions taken. Nationwide efforts should be channeled into addressing the knowledge-to-action gap.
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BACKGROUND: Mixed evidence exists regarding the effectiveness of the Chronic Care Model (CCM) with patient outcomes. The aim of this review is to examine the effectiveness of CCM interventions on hemoglobin A1c (HbA1c), systolic BP (SBP), diastolic BP (DBP), LDL cholesterol and body mass index (BMI) among primary care adults with type 2 diabetes. METHODS: PubMed, Embase, CINAHL, Cochrane Central Registry of Controlled Trials, Scopus and Web of Science were searched from January 1990 to June 2021 for randomized controlled trials (RCTs) comparing CCM interventions against usual care among adults with type 2 diabetes mellitus in primary care with HbA1c, SBP, DBP, LDL cholesterol and BMI as outcomes. An abbreviated search was performed from 2021 to April 2022. This study followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines for data extraction and Cochrane risk of bias assessment. Two reviewers independently extracted the data. Meta-analysis was performed using Review Manager software. Heterogeneity was evaluated using χ2 and I2 test statistics. Overall effects were evaluated using Z statistic. RESULTS: A total of 17 studies involving 16485 patients were identified. Most studies had low risks of bias. Meta-analysis of all 17 studies revealed that CCM interventions significantly decreased HbA1c levels compared to usual care, with a mean difference (MD) of -0.21%, 95% CI -0.30, -0.13; Z = 5.07, p<0.00001. Larger effects were experienced among adults with baseline HbA1c ≥8% (MD -0.36%, 95% CI -0.51, -0.21; Z = 5.05, p<0.00001) and when four or more CCM elements were present in the interventions (MD -0.25%, 95% CI -0.35, -0.15; Z = 4.85, p<0.00001). Interventions with CCM decreased SBP (MD -2.93 mmHg, 95% CI -4.46, -1.40, Z = 3.75, p=0.0002) and DBP (MD -1.35 mmHg, 95% CI -2.05, -0.65, Z = 3.79, p=0.0002) compared to usual care but there was no impact on LDL cholesterol levels or BMI. CONCLUSIONS: CCM interventions, compared to usual care, improve glycaemic control among adults with type 2 diabetes in primary care, with greater reductions when the mean baseline HbA1c is ≥8% and with interventions containing four or more CCM elements. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021273959.
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Diabetes Mellitus Tipo 2 , Adulto , Humanos , LDL-Colesterol , Diabetes Mellitus Tipo 2/terapia , Hemoglobinas Glicadas , Índice de Massa Corporal , Atenção Primária à SaúdeRESUMO
AIMS: To examine the prevalence of chronic musculoskeletal (MSK) pain and its association with diabetes self-management, glycemic control and health-related quality of life (HRQoL) in patients with diabetes mellitus (DM) in primary care. METHODS: 329 patients with type 2 DM were recruited at public primary care clinics in Hong Kong. Chronic MSK pain was defined as having MSK pain ≥ 3 months, and the pain severity was measured by Brief Pain Inventory (BPI). Diabetes Management Self-Efficacy Scale (DMSES), hemoglobin A1c (HbA1c) and EuroQuol-5D (EQ5D) were collected. Multivariable regression was used to examine the association between the presence of chronic MSK pain with DMSES, HbA1c and EQ5D, adjusted for baseline confounders such as age, sex, BMI, duration of DM and comorbid depression. RESULTS: Approximately 49.5% of respondents reported chronic MSK pain with a median BPI severity score of 3.5 (2.0-5.0). The presence of chronic MSK pain was associated with lower HRQoL (ß = -0.053, 95% CI -0.087 to -0.018, P = 0.003), but was not associated with the diabetes self-management and glycemic control. Depression was associated with poorer diabetes self-management (ß = -2.776, 95% CI -4.247 to -1.304, P < 0.001) and HRQoL.( ß = -0.018,95% CI-0.025 to -0.012, P < 0.001). CONCLUSIONS: Chronic MSK pain was present in nearly half of the diabetic patients in primary care; however, the degree of pain was mild and had not shown to affect diabetes self-management and glycemic control. Depression was associated with poorer diabetes self-management. Chronic MSK pain and depression were both associated with poorer HRQoL.
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Diabetes Mellitus Tipo 2 , Dor Musculoesquelética , Autogestão , China/epidemiologia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/terapia , Hemoglobinas Glicadas , Controle Glicêmico , Humanos , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/epidemiologia , Dor Musculoesquelética/terapia , Prevalência , Atenção Primária à Saúde , Qualidade de VidaRESUMO
BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) is closely associated with diabetes. The cumulative impact of both diseases synergistically increases risk of adverse events. However, present population analysis is predominantly conducted with reference to non-NAFLD individuals and has not yet examined the impact of prediabetes. Hence, we sought to conduct a retrospective analysis on the impact of diabetic status in NAFLD patients, referencing non-diabetic NAFLD individuals. METHODS: Data from the National Health and Nutrition Examination Survey 1999-2018 was used. Hepatic steatosis was defined with United States Fatty Liver Index (US-FLI) and FLI at a cut-off of 30 and 60 respectively, in absence of substantial alcohol use. A multivariate generalized linear model was used for risk ratios of binary outcomes while survival analysis was conducted with Cox regression and Fine Gray model for competing risk. RESULTS: Of 32,234 patients, 28.92% were identified to have NAFLD. 36.04%, 38.32% and 25.63% were non-diabetic, prediabetic and diabetic respectively. Diabetic NAFLD significantly increased risk of cardiovascular disease (CVD), stroke, chronic kidney disease, all-cause and CVD mortality compared to non-diabetic NAFLD. However, prediabetic NAFLD only significantly increased the risk of CVD and did not result in a higher risk of mortality. CONCLUSION: Given the increased risk of adverse outcomes, this study highlights the importance of regular diabetes screening in NAFLD and adoption of prompt lifestyle modifications to reduce disease progression. Facing high cardiovascular burden, prediabetic and diabetic NAFLD individuals can benefit from early cardiovascular referrals to reduce risk of CVD events and mortality.
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Doenças Cardiovasculares , Diabetes Mellitus , Hepatopatia Gordurosa não Alcoólica , Estado Pré-Diabético , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Humanos , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Inquéritos Nutricionais , Estado Pré-Diabético/complicações , Estado Pré-Diabético/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de RiscoRESUMO
INTRODUCTION: Through the INTernational ConsoRtium of Primary Care BIg Data Researchers (INTRePID), we compared the pandemic impact on the volume of primary care visits and uptake of virtual care in Australia, Canada, China, Norway, Singapore, South Korea, Sweden, the UK and the USA. METHODS: Visit definitions were agreed on centrally, implemented locally across the various settings in INTRePID countries, and weekly visit counts were shared centrally for analysis. We evaluated the weekly rate of primary care physician visits during 2019 and 2020. Rate ratios (RRs) of total weekly visit volume and the proportion of weekly visits that were virtual in the pandemic period in 2020 compared with the same prepandemic period in 2019 were calculated. RESULTS: In 2019 and 2020, there were 80 889 386 primary care physician visits across INTRePID. During the pandemic, average weekly visit volume dropped in China, Singapore, South Korea, and the USA but was stable overall in Australia (RR 0.98 (95% CI 0.92 to 1.05, p=0.59)), Canada (RR 0.96 (95% CI 0.89 to 1.03, p=0.24)), Norway (RR 1.01 (95% CI 0.88 to 1.17, p=0.85)), Sweden (RR 0.91 (95% CI 0.79 to 1.06, p=0.22)) and the UK (RR 0.86 (95% CI 0.72 to 1.03, p=0.11)). In countries that had negligible virtual care prepandemic, the proportion of visits that were virtual were highest in Canada (77.0%) and Australia (41.8%). In Norway (RR 8.23 (95% CI 5.30 to 12.78, p<0.001), the UK (RR 2.36 (95% CI 2.24 to 2.50, p<0.001)) and Sweden (RR 1.33 (95% CI 1.17 to 1.50, p<0.001)) where virtual visits existed prepandemic, it increased significantly during the pandemic. CONCLUSIONS: The drop in primary care in-person visits during the pandemic was a global phenomenon across INTRePID countries. In several countries, primary care shifted to virtual visits mitigating the drop in in-person visits.
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COVID-19 , Telemedicina , Big Data , COVID-19/epidemiologia , Humanos , Pandemias , Atenção Primária à Saúde , SARS-CoV-2RESUMO
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) affects one-fourth of the global population. Yet, the care of these patients is limited and awareness of NAFLD remains low in the general public. Investigations into the lives of these patients are often forgotten and traditional quantitative studies only paint part of the picture. AIM: To assess the first-hand accounts of these individuals and their perspective on living with NAFLD. METHODS: A systematic search was conducted on Medline, Embase, CINAHL, PsycINFO and Web of Science database for qualitative literature regarding patients' perspectives on NAFLD. An inductive thematic analysis was conducted to generate themes and supportive subthemes. RESULTS: We incuded eight articles in the review. There were three major themes including the impact on the quality of life, knowledge and information, and attitudes and perceptions on care. The impact of the quality of life details the emotional and physical distress of NAFLD. Knowledge and information include the lack of sufficient communication between healthcare providers and patients with a distinct knowledge gap. Attitudes and perceptions on care extrapolate the current active participation of patients and needs of the patients and the future care that they desire. CONCLUSION: This review synthesises first-hand accounts of individuals with NAFLD. With the growing burden of NAFLD, future public interventions must consider individual views for success to be found. The identified themes serve as a forefront for consideration for public policies. Ultimately, NAFLD is a multisystem disease, which must be managed by a multidisciplinary team.
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Hepatopatia Gordurosa não Alcoólica , Pessoal de Saúde , Humanos , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Qualidade de Vida/psicologiaRESUMO
OBJECTIVE/BACKGROUND: This study sought to uncover the perspectives of various stakeholders towards multidisciplinary team (MDT) care, discover new understandings and help inform current practice on MDT care for diabetic patients. METHODS: 5 electronic databases were searched for articles that evaluated patients' and providers' perspectives on type 2 Diabetes Mellitus (T2DM) MDT management. Articles retrieved were sieved, coded and findings were analytically themed together in accordance to Thomas and Harden methodology. RESULTS: 15 articles were identified with three common themes: interactions between healthcare providers, benefits to patients and constraints and facilitators of the healthcare system. Trust and synergistic teamwork are important factors in promoting effective care. Patients commended MDT's improved accessibility and convenience and felt more welcomed. Often plagued by poor support, lack of manpower and resources, MDTs are less efficient and incapable of realizing their full potential. CONCLUSION: This review illustrates that the MDT model does improve diabetes treatment outcome, help prevent or reduce complications. Nevertheless, the MDT model can be a double-edged sword as poor interactions between HCPs can hamper quality patient care. The current MDT model is also based on available resources of the health system. More effort is needed to modify the MDT model to meet the changing needs of patients.
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Atitude do Pessoal de Saúde , Diabetes Mellitus Tipo 2/terapia , Conhecimentos, Atitudes e Prática em Saúde , Equipe de Assistência ao Paciente , Satisfação do Paciente , Terapia Combinada , Comportamento Cooperativo , Diabetes Mellitus Tipo 2/diagnóstico , Humanos , Comunicação Interdisciplinar , Atenção Primária à Saúde , Indicadores de Qualidade em Assistência à SaúdeRESUMO
INTRODUCTION: Diabetes self-management education is a key aspect in the long-term management of type 2 diabetes. The patient and healthcare professional (HCP) perspective on the use of technology-assisted DSME has yet to be studied. Hence, the objective of this study was to better understand the factors that facilitate or hinder the adoptions of such education by adults with type 2 diabetes and their HCPs. METHODS: We systematically searched five databases (Medline, Embase, CINAHL, Web of Science Core Collection, and PsycINFO) until August 2019. The search included qualitative and mixed-method studies that reported the views of patients and HCPs regarding features, uses, and implementations of technology-assisted DSME. Data were synthesized through an inductive thematic analysis. RESULTS: A total of 13 articles were included, involving 242 patients, ranging from 18 to 81 years and included web-based, mobile application, digital versatile disc (DVD), virtual reality or telehealth interventions. Patients and HCPs had mixed views towards features of the technology-assisted interventions, with patients' personal qualities and HCPs' concerns affecting uses of the interventions. Patients generally preferred technologies that were easy to access, use, and apply and that had reliable information. Patients' ambitions motivated them, and personal attributes such as poor competence with technology, poor literacy, and language barriers acted as barriers. Patients especially liked the peer support that they received but did not like it when there was no regulation of advice on these platforms. HCPs believed that while the interventions were useful to patients, they faced difficulties with integration into their clinical workflows. CONCLUSION: This review explored the features of technology-assisted diabetes self-management education interventions that enhanced positive patient engagements and the negative aspects of both the platforms and the target groups. Technical support and training will be effective in managing these concerns and ensuring meaningful use of these platforms.
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Tecnologia Educacional/métodos , Pessoal de Saúde/psicologia , Educação de Pacientes como Assunto/métodos , Autogestão/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2 , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Adulto JovemRESUMO
With coronavirus disease 2019 declared a Public Health Emergency of International Concern on 30 January 2020, occupational health services in a tertiary hospital in Singapore stepped up via a three-pronged approach, namely, protection of individual staff, protection of staff workforce, and prevention of nosocomial spread so as to support business continuity plans. Despite the multiple new challenges brought by the COVID-19 pandemic, the hospital's occupational health services were able to adapt and keep all employees and patients safe with strong support from senior management and close collaboration with various departments.
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Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Serviços de Saúde do Trabalhador/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Centros de Atenção Terciária/organização & administração , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecção Hospitalar/virologia , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , SARS-CoV-2 , Singapura/epidemiologiaRESUMO
Infantile colic is a common self-limiting condition that causes significant distress to parents and caregivers. There is no clear cause, gold standard remedy or preventative action. The role of the family physician is to rule out sinister causes while providing counselling and reassurance for parents. The mainstay of management is parental support and reassurance while looking out for red flags in the baby such as fever, lethargy, distended abdomen and failure to thrive. This article provides a framework to approaching infantile colic and practical pointers to share with parents.
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Cólica/diagnóstico , Cólica/terapia , Pediatria/métodos , Atenção Primária à Saúde/métodos , Cuidadores , Choro , Medicina Baseada em Evidências , Humanos , Lactente , Fórmulas Infantis , Recém-Nascido , Hipertonia Muscular/diagnóstico , Poder Familiar , Pais , Médicos de Família , Relações Profissional-PacienteRESUMO
BACKGROUND: Illness perceptions (IP) involve coping strategies and behavioural responses that can influence glycaemic control. Despite the importance of good glycaemic control, the majority of patients in Asia are not achieving glycaemic targets. An evaluation of IP in association with glycaemic control, medication adherence and chronic kidney disease (CKD) in Type 2 diabetes mellitus patients (T2DM) was carried out in an outpatient setting in Malaysia METHOD: A cross-sectional study was conducted using the Revised Illness Perception Questionnaire in a purposive sample of 384 T2DM patients. RESULTS: There were 55.7% females, median age was 58.2 years and median duration of diabetes was 13 years. The majority (79.4%) of patients had poor diabetes control (HbA1câ¯≥â¯7.0%) and 39.6% of patients had low medication adherence. Patients with good glycaemic control had a higher Timeline Acute/Chronic and Emotional Representations score, hence they held the correct belief that diabetes is chronic and experienced negative emotions. Highly adherent patients had a higher Illness Coherence (χ2â¯=â¯21.385, pâ¯<â¯0.001) score but a lower Consequences (χ2â¯=â¯17.592, pâ¯<â¯0.001) and Emotional Representations (χ2â¯=â¯16.849, pâ¯<â¯0.001) score indicating good understanding and less negative perceptions of disease burden. Patients in a more advanced stage of CKD had a significantly higher Timeline Cyclical score (χ2â¯=â¯18.718, pâ¯=â¯0.001), believing that diabetes was unpredictable. CONCLUSION: Dimensions of IP have been shown to be significantly associated with the assessed variables, therefore intervention studies with education, support and counselling should be conducted in Asia with the ultimate aim of empowering patients through IP-targeted management.