Survey of provider perspectives on patient assistance programs.
Ontology highlight
ABSTRACT:
SUBMITTER: Buell R
PROVIDER: S-EPMC2795420 | biostudies-other | 2009 Jul
REPOSITORIES: biostudies-other
Publications
Survey of provider perspectives on patient assistance programs.
Journal of oncology practice 20090701 4
This survey attempts to quantify the costs of applying for patient assistance programs, which oncologists say too often involves weeks of paperwork, repeated telephone calls, and bureaucratic delays. ...[more]
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Project description:BACKGROUND:The worldwide rise in common mental disorders (CMDs) is posing challenges in the provision of and access to care, particularly for immigrant, refugee and racialized groups from low-income backgrounds. eHealth tools, such as the Interactive Computer-Assisted Client Assessment Survey (iCCAS) may reduce some barriers to access. iCCAS is a tablet-based, touch-screen self-assessment completed by clients while waiting to see their family physician (FP) or nurse practitioner (NP). In an academic-community initiative, iCCAS was made available in English and Spanish at a Community Health Centre in Toronto through a mixed-method trial. METHODS:This paper reports the perspectives of clients in the iCCAS group (n?=?74) collected through an exit survey, and the perspectives of 9 providers (four FP and five NP) gathered through qualitative interviews. Client acceptance of the tool was assessed for cognitive and technical dimensions of their experience. They rated twelve items for perceived Benefits and Barriers and four questions for the technical quality. RESULTS:Most clients reported that the iCCAS completion time was acceptable (94.5 %), the touch-screen was easy to use (97.3 %), and the instructions (93.2 %) and questions (94.6 %) were clear. Clients endorsed the tool's Benefits, but were unsure about Barriers to information privacy and provider interaction (mean 4.1, 2.6 and 2.8, respectively on a five-point scale). Qualitative analysis of the provider interviews identified five themes: challenges in Assessing Mental Health Services, such as case complexity, time, language and stigma; the Tool's Benefits, including non-intrusive prompting of clients to discuss mental health, and facilitation of providers' assessment and care plans; the Tool's Integration into everyday practice; Challenges for Use (e.g. time); and Promoting Integration Effectively, centered on the timing of screening, setting readiness, language diversity, and technological advances. CONCLUSIONS:Participant clients and providers perceived iCCAS as an easy and useful tool for mental health assessments at the Community Health Centre and similar settings. The findings are anticipated to inform further work in this area. TRIAL REGISTRATION:ClinicalTrials.gov; NCT02023957 ; Registered retrospectively 12 Dec. 2013.
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Project description:BACKGROUND:One-third of Americans use social media websites as a source of health care information. Twitter, a microblogging site that allows users to place 280-character posts-or tweets-on the Web, is emerging as an important social media platform for health care. However, most guidelines on medical professionalism on social media are based on expert opinion. OBJECTIVE:This study sought to examine if provider Twitter profiles with educational tweets were viewed as more professional than profiles with personal tweets or a mixture of the two, and to determine the impact of provider gender on perceptions of professionalism in an academic obstetrics and gynecology clinic. METHODS:This study randomized obstetrics and gynecology patients at the University of Michigan Von Voigtlander Clinic to view one of six medical provider Twitter profiles, which differed in provider gender and the nature of tweets. Each participant answered 10 questions about their perception of the provider's professionalism based on the Twitter profile content. RESULTS:The provider profiles with educational tweets alone received higher mean professionalism scores than profiles with personal tweets. Specifically, the female and male provider profiles with exclusively educational tweets had the highest and second highest overall mean professionalism ratings at 4.24 and 3.85, respectively. In addition, the female provider profiles received higher mean professionalism ratings than male provider profiles with the same content. The female profile with mixed content received a mean professionalism rating of 3.38 compared to 3.24 for the male mixed-content profile, and the female profile with only personal content received a mean professionalism rating of 3.68 compared to 2.68 for the exclusively personal male provider profile. CONCLUSIONS:This study showed that in our obstetrics and gynecology clinic, patients perceived providers with educational profiles as more professional than those with a mixture of educational and personal tweets or only personal tweets. It also showed that our patient population perceived the female provider with educational tweets to be the most professional. This study will help inform the development of evidence-based guidelines for social media use in medicine as it adds to the growing body of literature examining professionalism and social media.
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Project description:Objective:To compare patients' and providers' views on contributors to 30-day hospital readmissions. Design:Analysis of a qualitative interview survey between 18 May-30 June 2015. Setting:Interviews were conducted during the 30-day readmission hospitalisation at a single tertiary care academic hospital. Participants:We conducted 178 interviews of readmitted patients. Measures:We queried opinions of what factors patients believed contributed to their rehospitalisation and compared this with the perspective of the index admission provider. The primary outcome was the view that the readmission was preventable. A review by a RN (nurse) case manager also provided an assessment based on patient report, provider report and chart review. Results:Patients were more likely to view a readmission as preventable compared with physicians (p<0.0001). Patients identified system issues (defined as factors controlled by the hospital discharge process) as contributors to their readmission in 58% (103/178) of cases while providers identified system issues as the contributor to a patients' readmission in 2% (2/101) of cases. Patients with poor functional status were more likely to feel the cause of their readmission was due to system issues than patients with better functional status (p=0.03). A RN case manager review determined that in 48% (86/178) of cases the system had some amount of contribution to a patient's readmission. There was no significant difference in belief that the readmission was preventable between the RN case manager and the patient (p=0.47). Conclusions:Readmitted patients often feel that the hospital system contributed to their readmission. Providers did not recognise patient and RN case manager identified issues as contributors to hospital readmissions.
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Project description:ImportanceAlthough independent charity patient assistance programs improve patient access to costly prescription drugs, recent federal investigations have raised questions about their potential to increase pharmaceutical spending and to violate the federal Anti-Kickback Statute. Little is known about the design of the programs, patient eligibility, or drug coverage.ObjectiveTo examine the eligibility criteria of the independent charity patient assistance programs and the drugs covered by them.Design, setting, and participantsDescriptive cross-sectional study of the 6 largest independent charities offering patient assistance programs for patients including, but not limited to, Medicare beneficiaries in 2018. These charities offered 274 different disease-specific patient assistance programs. Drugs were identified for subgroup analysis that had any use reported on the Medicare Part D spending dashboard and any off-patent brand-name drugs that incurred more than $10?000 in Medicare spending per beneficiary in 2016.ExposuresSupport by independent charity patient assistance programs.Main outcomes and measuresThe primary outcomes were the characteristics of patient assistance programs, including assistance type, insurance coverage (vs uninsured), and income eligibility. The secondary outcomes were the cost of the drugs covered by the patient assistance programs and the coverage of expensive off-patent brand-name drugs vs substitutable generic drugs.ResultsAmong the 6 independent charity foundations included in the analysis, their total revenue in 2017 ranged from $24 million to $532 million, and expenditures on patient assistance programs ranged from $24 million to $353 million, representing on average, 86% of their revenue. Of the 274 patient assistance programs offered by these organizations, 168 (61%) provided only co-payment assistance, and the most common therapeutic area covered was cancer or cancer treatment-related symptoms (113 patient assistance programs; 41%). A total of 267 programs (97%) required insurance coverage as an eligibility criterion (ie, excluded uninsured patients). The most common income eligibility limit was 500% of the federal poverty level. The median annual cost of the drugs per beneficiary covered by the programs was $1157 (interquartile range, $247-$5609) compared with $367 (interquartile range, $100-$1500) for the noncovered drugs. Off-patent brand-name drugs (cost: >$10?000) were covered by a mean of 3.1 (SD, 2.0) patient assistance programs, whereas their generic equivalents were covered by a mean of 1.2 (SD, 1.0) patient assistance programs.Conclusions and relevanceIn 2018, among 274 patient assistance programs operated by the 6 independent charity foundations, the majority did not provide coverage for uninsured patients. Medications that were covered by the patient assistance programs were generally more expensive than those that were not covered.
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Project description:One of the significant modifications to the Common Rule is the requirement that prospective participants be given information sufficient for a "reasonable person." However, research is limited on what types of information patients, caregivers, and providers consider "key information." Although certain aspects of informed consent (IC) may be considered standard, considering the individualized needs and preferences of patients is necessary for patient-centered consent. In this study, we qualitatively examined the specific types of information that patients and caregivers involved in hematopoietic cell transplantation (HCT), as well as their providers, believe to be important and necessary as part of the IC process to make a decision about participating in clinical research; and further, how these perspectives are aligned. Our findings suggest opportunities for improving the IC document and process by emphasizing information of importance to patients, such as the benefits to others and contributions to science that are associated with participation in clinical research. Furthermore, increasing patient engagement during the IC process may allow providers to streamline information that is aligned with patient information needs and preferences.
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Project description:Background. A culture of stringent drug policy, one-size-fits-all treatment approaches, and drug-related stigma has clouded clinical HIV practice in the United States. The result is a series of missed opportunities in the HIV care environment. An approach which may address the broken relationship between patient and provider is harm reduction-which removes judgment and operates at the patient's stage of readiness. Harm reduction is not a routine part of care; rather, it exists outside clinic walls, exacerbating the divide between compassionate, stigma-free services and the medical system. Methods. Qualitative, phenomenological, semi-structured, individual interviews with patients and providers were conducted in three publicly-funded clinics in Chicago, located in areas of high HIV prevalence and drug use and serving African-American patients (N = 38). A deductive thematic analysis guided the process, including: the creation of an index code list, transcription and verification of interviews, manual coding, notation of emerging themes and refinement of code definitions, two more rounds of coding within AtlasTi, calculation of Cohen's Kappa for interrater reliability, queries of major codes and analysis of additional common themes. Results. Thematic analysis of findings indicated that the majority of patients felt receptive to harm reduction interventions (safer injection counseling, safer stimulant use counseling, overdose prevention information, supply provision) from their provider, and expressed anticipated gratitude for harm reduction information and/or supplies within the HIV care visit, although some were reluctant to talk openly about their drug use. Provider results were mixed, with more receptivity reported by advanced practice nurses, and more barriers cited by physicians. Notable barriers included: role-perceptions, limited time, inadequate training, and the patients themselves. Discussion. Patients are willing to receive harm reduction interventions from their HIV care providers, while provider receptiveness is mixed. The findings reveal critical implications for diffusion of harm reduction into HIV care, including the need to address cited barriers for both patients and providers to ensure feasibility of implementation. Strategies to address these barriers are discussed, and recommendations for further research are also shared.
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