Patient Work and Their Contexts: Scoping Review.

BACKGROUND: Having patients self-manage their health conditions is a widely promoted concept, but many patients struggle to practice it effectively. Moreover, few studies have analyzed the nature of work required from patients and how such work fits into the context of their daily life. OBJECTIVE: This study aimed to review the characteristics of patient work in adult patients. Patient work refers to tasks that health conditions impose on patients (eg, taking medications) within a system of contextual factors. METHODS: A systematic scoping review was conducted using narrative synthesis. Data were extracted from PubMed, Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO, including studies from August 2013 to August 2018. The included studies focused on adult patients and assessed one or more of the following: (1) physical health-related tasks, (2) cognitive health-related tasks, or (3) contextual factors affecting these tasks. Tasks were categorized according to the themes that emerged: (1) if the task is always visible to others or can be cognitive, (2) if the task must be conducted collaboratively or can be conducted alone, and (3) if the task was done with the purpose of creating resources. Contextual factors were grouped according to the level at which they exert influence (micro, meso, or macro) and where they fit in the patient work system (the macroergonomic layer of physical, social, and organizational factors; the mesoergonomic layer of household and community; and the microergonomic triad of person-task-tools). RESULTS: In total, 67 publications were included, with 58 original research articles and 9 review articles. A variety of patient work tasks were observed, ranging from physical and tangible tasks (such as taking medications and visiting health care professionals) to psychological and social tasks (such as creating coping strategies). Patient work was affected by a range of contextual factors on the micro, meso, or macro levels. Our results indicate that most patient work was done alone, in private, and often imposing cognitive burden with low amounts of support. CONCLUSIONS: This review sought to provide insight into the work burden of health management from a patient perspective and how patient context influences such work. For many patients, health-related work is ever present, invisible, and overwhelming. When researchers and clinicians design and implement patient-facing interventions, it is important to understand how the extra work impacts one's internal state and coping strategy, how such work fits into daily routines, and if these changes could be maintained in the long term.

Implementation of an innovative surgical pharmacy service to improve patient outcomes-Twelve-month outcomes of the Enhanced Surgical Medicines Optimization Service.

WHAT IS KNOWN AND OBJECTIVE: Pharmacists play vital roles in medicines optimization in different care settings. Studies have shown that optimizing patient's pre-existing co-morbidities prior to the surgery leads to better post-operative outcomes. The Enhanced Surgical medicines optimization service (ESMOS) is an innovative surgical pharmacy service introduced at a large teaching hospital in the UK in September 2017 which aimed to reduce the length of stay and post-operative complications in general surgical patients. This purpose of this study is to evaluate the implementation and outcomes of this service at 12 months after it was rolled out. METHODS: This cohort study was undertaken between September 2017 and September 2018. Adult patients undergoing elective major general surgical procedures were included and stratified into four sub-specialties, including hepato-pancreato-biliary (HPB), upper gastrointestinal (GI), lower GI and vascular surgery. Patients undergoing emergency and day case procedures or with missing outcome data were excluded from this study. Patients' demographics, baseline co-morbidities, high-risk medications, American Society of Anaesthesiologists (ASA) physical status classification, surgical procedure, post-operative complications, length of stay and nature of pharmacist interventions were collected and reported by descriptive statistics. Length of stay was compared with the corresponding expected length of stay by the national standard. RESULTS AND DISCUSSION: A total of 246 patients were included in the four general sub-specialties: HPB (n = 82), upper GI (n = 17), lower GI (n = 87) and vascular (n = 60). There was a significant reduction in the median length of stay in three surgical specialties, compared with the national standard: lower GI (median reduction: -2; IQR: -4, 1.8; P = .038), HPB (median reduction: -4.5; IQR: -7, -1; P = .001) and vascular (median reduction: -2; IQR: -4, 0; P = .043). WHAT IS NEW AND CONCLUSION: The ESMOS model is a novel care pathway that allows both early identification of medicines optimization and peri-operative drug management issues in surgical patients, and potentially reduces the overall length of stay.