Dataset Information

Proposal for a Global Adherence Scale for Acute Conditions (GASAC): A prospective cohort study in two emergency departments.

ABSTRACT: BACKGROUND:Adherence in the context of patients with acute conditions is a major public health issue. It is neglected by the research community and no clinically validated generic scale exists to measure it. OBJECTIVE:To construct and validate a Global Adherence Scale usable in the context of Acute Conditions (GASAC) that takes into account adherence both to advice and to all types of prescriptions that the doctor may give. To measure adherence and to study its determinants. MATERIALS AND METHOD:We based the construction of the GASAC questionnaire on a theoretical model and a literature search. Then, between 2013 and 2014, we validated it in a prospective observational study in two hospital emergency departments. Patients were contacted by phone about one week after their consultation to answer several questionnaires, including GASAC and the Girerd self-administered questionnaire about medication adherence as a control. RESULTS:GASAC consists of four adherence subscales: drug prescriptions; blood tests/ radiography prescriptions; lifestyle advice and follow-up instructions. An analysis of the 154 sets of answers from patients showed that the GASAC drug subscale had satisfactory internal coherence (Cronbach's alpha = 0.78) and was correlated with the Girerd score, as was GASAC as a whole (p<0.01). The median score was 0.93 IQR [0.78-1] for a maximum value of 1 (n = 154). In multivariaable analysis, infection was more conducive of good adherence (cut off at ? 0.8; n = 115/154; 74.7% [67.0-81.3]) than trauma (OR 3.69; CI [1.60-8.52]). The Doctor-Patient Communication score (OR 1.06 by score point, CI [1.02-1.10]) also influenced adherence. CONCLUSIONS:GASAC is a generic score to measure all dimensions of patient adherence following emergency departments visits, for use in clinical research and the evaluation of clinical practice. The level of adherence was high for acute conditions and Doctor-Patient Communication was a major determinant of adherence.

SUBMITTER: Sustersic M

PROVIDER: S-EPMC6903735 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Proposal for a Global Adherence Scale for Acute Conditions (GASAC): A prospective cohort study in two emergency departments.

Sustersic Mélanie M Gauchet Aurélie A Duvert Amélie A Gonnet Laure L Foote Alison A Vermorel Céline C Allenet Benoit B Bosson Jean-Luc JL

PloS one 20191210 12

<h4>Background</h4>Adherence in the context of patients with acute conditions is a major public health issue. It is neglected by the research community and no clinically validated generic scale exists to measure it.<h4>Objective</h4>To construct and validate a Global Adherence Scale usable in the context of Acute Conditions (GASAC) that takes into account adherence both to advice and to all types of prescriptions that the doctor may give. To measure adherence and to study its determinants.<h4>Ma ...[more]

PMID: 31821336

Similar Datasets

Project description:IntroductionAdverse events (AEs), defined as unintended patient harm related to healthcare provided rather than an underlying medical condition, represent a significant threat to patient safety and public health. The emergency department (ED) is a high-risk patient safety setting for many reasons including presentation 'outside of regular hours', high patient volumes, and a chaotic work environment. Children have also been identified as particularly vulnerable to AEs. Despite the identification of the ED as a high-risk setting and the vulnerability of the paediatric population, little research has been conducted regarding paediatric patient safety in the ED. The study objective is to generate an estimate of the risk and type of AEs, as well as their preventability and severity, for children seen in Canadian paediatric EDs.Methods and analysisThis multicentre, prospective cohort study will enrol patients under 18 years of age from nine paediatric EDs across Canada. A stratified cluster random sampling scheme will be used to ensure patients recruited are representative of the overall ED population. A rigorous, standardised two-stage process will be used for AE identification. The primary outcome will be the proportion of children with AEs associated with ED care in the 3 weeks following the ED visit. Secondary outcomes will include the proportion of children with preventable AEs and the types and severity of AEs. We will aim to recruit 5632 patients over 1 year and this will allow us to detect a proportion of patients with an AE of 5% (to within an absolute margin of error of 0.6%).Ethics and disseminationEthics approval has been obtained from participating sites. Results will be disseminated through presentations, peer review publications, linkages with emergency research network and a webinars for key knowledge user groups.Trial registration numberThis study is registered at Clinicaltrials.gov (NCT02162147; https://clinicaltrials.gov/ct2/show/NCT02162147).

Project description:OBJECTIVE:In the context of acute conditions seen in an emergency department, where communication may be difficult, patient information leaflets (PILs) could improve doctor-patient communication (DPC) and may have an impact on other outcomes of the consultation. Our objective was to assess the impact of PILs on DPC, patient satisfaction and adherence, and on patient and doctor behaviours. DESIGN:Prospective, controlled, before-after trial between November 2013 and June 2015. SETTING:Two French emergency departments. PARTICIPANTS:Adults and adolescents >15 years diagnosed with ankle sprain or an infection (diverticulitis, infectious colitis, pyelonephritis, pneumonia or prostatitis). INTERVENTION:Physicians in the intervention group gave patients a PIL about their condition along with an oral explanation. MAIN OUTCOME MEASURES:7-10 days later, patients were contacted by phone to answer questionnaires. Results were derived from questions scored using a 4-point Likert scale. MAIN FINDINGS:Analysis of the 324 patients showed that PILs improved the mean DPC score (range: 13-52), with 46 (42-49) for 168 patients with PILs vs 44 (38-48) for 156 patients without PILs (p<0.01). The adjusted OR for good communication (having a score >35/52) was 2.54 (1.27 to 5.06). The overall satisfaction and adherence scores did not show significant differences. In contrast, satisfaction with healthcare professionals and timing of medication intake were improved with PILs. The overall satisfaction score improved significantly on per-protocol analysis. When using PILs, doctors prescribed fewer drugs and more examinations (radiology, biology, appointment with a specialist); the need for a new medical consultation for the same pathology was reduced from 32.1% to 17.9% (OR 0.46 [0.27 to 0.77]), particularly revisiting the emergency department. CONCLUSION:In emergency departments, PILs given by doctors improve DPC, increase patients' satisfaction with healthcare professionals, reduce the number of emergency reconsultations for the same pathology and modify the doctor's behaviour. TRIAL REGISTRATION NUMBER:NCT02246361.

Project description:ObjectivesTo compare paediatric healthcare practice variation among five European emergency departments (EDs) by analysing variability in decisions about diagnostic testing, treatment and admission.Design and populationConsecutive paediatric visits in five European EDs in four countries (Austria, Netherlands, Portugal, UK) were prospectively collected during a study period of 9-36 months (2012-2015).Primary outcome measuresPractice variation was studied for the following management measures: lab testing, imaging, administration of intravenous medication and patient disposition after assessment at the ED.AnalysisMultivariable logistic regression was used to adjust for general patient characteristics and markers of disease severity. To assess whether ED was significantly associated with management, the goodness-of-fit of regression models based on all variables with and without ED as explanatory variable was compared. Management measures were analysed across different categories of presenting complaints.ResultsData from 111 922 children were included, with a median age of 4 years (IQR 1.7-9.4). There were large differences in frequencies of Manchester Triage System (MTS) urgency and selected MTS presentational flow charts. ED was a significant covariate for management measures. The variability in management among EDs was fairly consistent across different presenting complaints after adjustment for confounders. Adjusted OR (aOR) for laboratory testing were consistently higher in one hospital while aOR for imaging were consistently higher in another hospital. Iv administration of medication and fluids and admission was significantly more likely in two other hospitals, compared with others, for most presenting complaints.ConclusionsDistinctive hospital-specific patterns in variability of management could be observed in these five paediatric EDs, which were consistent across different groups of clinical presentations. This could indicate fundamental differences in paediatric healthcare practice, influenced by differences in factors such as organisation of primary care, diagnostic facilities and available beds, professional culture and patient expectations.

Dataset Information

Proposal for a Global Adherence Scale for Acute Conditions (GASAC): A prospective cohort study in two emergency departments.

Publications

Proposal for a Global Adherence Scale for Acute Conditions (GASAC): A prospective cohort study in two emergency departments.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets