"It just seems outside my health": How Patients with Chronic Conditions Perceive Communication Boundaries with Providers.
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ABSTRACT:
SUBMITTER: Lim C
PROVIDER: S-EPMC5553690 | biostudies-other | 2016 Jun
REPOSITORIES: biostudies-other
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Project description:ObjectiveExamine care integration-efforts to unify disparate parts of health care organizations to generate synergy across activities occurring within and between them-to understand whether and at which organizational level health systems impact care quality and staff experience.Data sourcesSurveys administered to one practice manager (56/59) and up to 26 staff (828/1360) in 59 practice sites within 24 physician organizations within 17 health systems in four states (2017-2019).Study designWe developed manager and staff surveys to collect data on organizational, social, and clinical process integration, at four organizational levels: practice site, physician organization, health system, and outside health systems. We analyzed data using descriptive statistics and regression.Principal findingsManagers and staff perceived opportunity for improvement across most types of care integration and organizational levels. Managers/staff perceived little variation in care integration across health systems. They perceived better care integration within practice sites than within physician organizations, health systems, and outside health systems-up to 38 percentage points (pp) lower (P < .001) outside health systems compared to within practice sites. Of nine clinical process integration measures, one standard deviation (SD) (7.2-pp) increase in use of evidence-based care related to 6.4-pp and 8.9-pp increases in perceived quality of care by practice sites and health systems, respectively, and a 4.5-pp increase in staff job satisfaction; one SD (9.7-pp) increase in integration of social services and community resources related to a 7.0-pp increase in perceived quality of care by health systems; one SD (6.9-pp) increase in patient engagement related to a 6.4-pp increase in job satisfaction and a 4.6-pp decrease in burnout; and one SD (10.6-pp) increase in integration of diabetic eye examinations related to a 5.5-pp increase in job satisfaction (all P < .05).ConclusionsMeasures of clinical process integration related to higher staff ratings of quality and experience. Action is needed to improve care integration within and outside health systems.
| S-EPMC7720712 | biostudies-literature
Project description:BackgroundIndividuals with disabilities living with chronic health conditions require self-management programs that are accessible, sustainable, inclusive, and adaptable. Health coaching is an effective approach to promoting behavior change in self-management. Health coaching combined with telehealth technology has the potential to improve the overall quality of, and access to, health services.ObjectiveThis protocol outlines the study design for implementing the My Health, My Life, My Way intervention. The study will assess the feasibility, acceptability, and preliminary efficacy of the intervention for people with disabilities and optimize it.MethodsThe My Health, My Life, My Way study is a 4-arm randomized controlled trial evaluating the delivery of a 6-month intervention involving telecoaching, inclusive educational content, and technology access for 200 individuals with chronic conditions and physical disabilities. This study uses the engineering-inspired multiphase optimization strategy (MOST) framework to evaluate intervention components and assess whether a combination or lack of individual elements influences behavior. Participants will be randomized to 1 of 4 study arms: scheduled coaching calls and gamified rewards, no scheduled coaching calls and gamified rewards, scheduled coaching calls and flat rewards, and no scheduled coaching calls and flat rewards.ResultsThe My Health, My Life, My Way study was approved by the institutional review board of the University of Alabama at Birmingham, and recruitment and enrollment will begin in May 2023. Data analysis is expected to be completed within 6 months of ending data collection. This clinical trial protocol was developed based on the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013 statement.ConclusionsThe My Health, My Life, My Way study will help to optimize and improve our understanding of the feasibility and efficacy of a web-based self-management program for people with physical disabilities and chronic conditions. More specifically, My Health, My Life, My Way will determine which combination of interventions (coaching calls and gamification) will result in increased participation in self-management programming. The My Health, My Life, My Way intervention has the potential to become a scalable and novel method to successfully manage chronic conditions in people with disabilities.Trial registrationClinicalTrials.gov NCT05481593; https://clinicaltrials.gov/ct2/show/NCT05481593.International registered report identifier (irrid)PRR1-10.2196/31694.
| S-EPMC10182470 | biostudies-literature
Project description:BackroundWorking condition surveys are widely recognized as useful tools for monitoring the quality of working life and the improvements introduced by health and safety policy frameworks at the European and national level. The Italian Workers' Compensation Authority carried out a national survey (Insula) to investigate the employer's perceptions related to working conditions and their impact on health.MethodsThe present study is based on the data collected from the Italian survey on health and safety at work (INSULA) conducted on a representative sample of the Italian workforce (n = 8,000). This focuses on the relationship between psychosocial risk factors and self-reported health using a set of logistic and linear regression models.ResultsWorking conditions such as managerial support, job satisfaction, and role act as protective factors on mental and physical health. On the contrary, workers' risk perceptions related to personal exposure to occupational safety and health risks, concern about health conditions, and work-related stress risk exposure determine a poorer state of health.ConclusionsThis study highlights the link between working conditions and self-report health, and this aims to provide a contribution in the field of health at work. Findings show that working conditions must be object of specific preventive measures to improve the workers' health and well-being.
| S-EPMC8430439 | biostudies-literature
Project description:BackgroundAlthough growing, the prevalence of the use of health information technology (HIT) by patients to communicate with their providers is not well understood on the population level, nor whether patients are communicating with their providers about their use of HIT.ObjectiveTo understand whether patients are communicating with their providers about HIT use and the patient characteristics associated with the communication.DesignCross-sectional, self-administered survey of a sample of patients across the state of Indiana.ParticipantsNine hundred seventy adult participants from across Indiana, 54% female and 79.5% white.Main measuresThe survey included sections assessing health information-seeking behavior, use of health information technology, and discussions with doctors about the use of HIT.Key resultsThe survey had a 12% response rate. Sixty-three percent of respondent reported going to the Internet as the first source when seeking health information, while only 19% of respondent reported their doctor was their first source. When communicating with doctors electronically, 31% reported using an electronic health record messaging system, 24% used email, and 18% used text messaging. Only 39% of respondents reported having had any conversation about HIT use with their providers.ConclusionsThere remain many unmet opportunities for patients and providers to communicate about HIT use. More guidance for patients and care teams may both help facilitate these conversations and promote optimal use, such as recommendations to ask simple clarification questions and minimize inefficient, synchronous communication when unnecessary.
| S-EPMC7459004 | biostudies-literature
Project description:Though there are extensive studies on neighborhood effects on health, this relationship remains elusive and requires continuous empirical evidence to support existing findings. Gentrification is a process of neighborhood change that affects most longtime residents. This study examined the health impact of the rapidly changing physical and cultural environment using oral history interviews, electronic interviews, and a quantitative structured survey. The study draws on the social determinants of health framework to explain the self-reported chronic health conditions (SR-CHCs) among 331 residents in Austin, Texas. The study employed non-linear techniques suitable for Poisson distribution to estimate the association between gentrification and SR-CHCs and complemented by direct quotes from in-depth interviews (IDIs). Perceived gentrification score significantly vary by marital status (p < 0.001), educational attainment (p < 0.001), and gender (p < 0.01), while SR-CHCs only significantly varies by educational attainment, p = 0.015). Multivariate results show that gentrification was positively associated with SR-CHCs, after adjusting for socioeconomic variables. Compared to the Hispanics, blacks were 97% more likely to report multiple counts of SR-CHCs (IRR = 1.969, 95% CI 1.074-3.608), and participants with high household income were 8% less likely to report multiple CHCs (IRR = 0.920, 95% CI 0.870-0.973). Drawing from the empirical findings, this study recommends both area-based and individual-level policies to mitigate neighborhood change's impact on residents' health. Finally, this study further adds to the understanding of social determinants of health in understanding chronic health within the changing urban physical and socio-ecology systems.Supplementary informationThe online version contains supplementary material available at 10.1007/s10901-021-09847-8.
| S-EPMC8107018 | biostudies-literature
Project description:IntroductionUsing cross-sectional survey data, we assessed the association between chronic illness burden and health-related self-efficacy, evaluating whether patient-centered communication is associated with self-efficacy and if that relationship varies by chronic illness burden.MethodsData were from the Health Information National Trends Survey, a cross-sectional survey of the US adult population collected in 2012-2013 (n = 3630). Health-related self-efficacy was measured with the item: "Overall, how confident are you about your ability to take good care of your health?" and the prevalence of six chronic conditions and depression/anxiety was assessed. Patient-centered communication was measured as the frequency with which respondents perceived their healthcare providers allowed them to ask questions, gave attention to their emotions, involved them in decisions, made sure they understood how to take care of their health, helped them to deal with uncertainty, and if they felt they could rely on their healthcare providers to take care of their healthcare needs.ResultsHealth-related self-efficacy was significantly lower among individuals with greater illness burden. In adjusted analysis, individuals who experienced more positive patient-centered communication reported higher levels of self-efficacy (β = 0.26, P < 0.0001); this association was strongest among those with greater illness burden.ConclusionHigher levels of self-efficacy were observed among patients reporting more positive patient-centered communication; the observed association was stronger among those with greater chronic illness burden.
| S-EPMC4969324 | biostudies-literature
Project description:PURPOSE:To assess the ability of My Family Health Portrait to accurately collect family history for six common heritable disorders. BACKGROUND:Family history is useful to assess disease risk but is not widely used. We compared the pedigree from My Family Health Portrait, an online tool for collection of family history, to a pedigree supplemented by a genetics professional. METHODS:One hundred fifty volunteers collected their family histories using My Family Health Portrait. A genetic counselor interviewed the volunteers to validate the entries and add diagnoses, as needed. The content and the affection assignments of the pedigrees were compared. The pedigrees were entered into Family Healthware to assess risks for the diseases. RESULTS:The sensitivity of My Family Health Portrait varied among the six diseases (67-100%) compared to the supplemented pedigree. The specificities ranged from 92 to 100%. When the pedigrees were used to generate risk scores, My Family Health Portrait yielded identical risks to the supplemented pedigree for 94-99% of the volunteers for diabetes and colon, breast, and ovarian cancer. The agreement was lower for coronary artery disease (68%) and stroke (83%). CONCLUSIONS:These data support the validity of My Family Health Portrait pedigrees for four common conditions--diabetes and colon, breast, and ovarian cancer. The tool performed less well for coronary artery disease and stroke. We recommend that the tool be improved to better capture information for these two common conditions.
| S-EPMC3258571 | biostudies-literature
Project description:Purpose: Effective communication between young adult (YA; aged 18-39 years) cancer survivors and their health care providers is critical for managing post-treatment symptoms. Yet, little is known about YAs' and providers' preferences for and barriers to symptom communication, variables important for developing interventions to improve and optimize YA-provider communication. Methods: YA survivors (N = 21) and oncology providers (N = 11) rank ordered their preferred methods for symptom communication and top communication barriers. Interviews were conducted to obtain qualitative data (i.e., preferred methods for, barriers, and suggestions to improve symptom communication). Interviews were transcribed, and thematic qualitative analysis was used. Results: Sixty-two percent of YAs preferred communicating using the electronic messaging system affiliated with the medical record (MyChart), whereas providers (100%) preferred communicating during in-person clinic visits. Qualitative data from YAs pointed to benefits of MyChart, including ease of use and rapid responses. Providers acknowledged that, although efficient, high message volumes and expectations for rapid responses were barriers to MyChart. Providers described benefits of in-person visits, including visually assessing patients' concerns, providing immediate support, and more safely managing symptoms. Lack of time (48%) was YAs' top communication barrier, whereas providers endorsed patients not bringing up symptoms (64%). Qualitative data reflected patient-level (e.g., embarrassment/discomfort, lack of skills) and provider-level (e.g., forgetting to ask about a symptom) barriers. YAs and providers offered strategies to improve communication. Conclusion: Survivor- and provider-level communication interventions that account for YAs' and providers' differing communication preferences and directly address communication barriers unique to survivors' developmental stage may be necessary to improve symptom communication.
| S-EPMC9595618 | biostudies-literature
Project description:The aim of this study was to synthesize published qualitative studies to identify older adults' preferences for communication about driving with health care providers.Health care providers play a key role in addressing driving safety and driving retirement with older adults, but conversations about driving can be difficult. Guides exist for family members and providers, but to date less is known about the types of communication and messages older drivers want from their health care providers.A qualitative metasynthesis of studies published on or before October 10, 2014, in databases (PubMed, CINAHL, PsycINFO, and Web of Science) and grey literature was performed.Twenty-two published studies representing 518 older adult drivers met the following inclusion criteria: the study (1) was about driving; (2) involved older drivers; (3) was qualitative (rather than quantitative or mixed methods); and (4) contained information on older drivers' perspectives about communication with health care providers.We identified 5 major themes regarding older adults' communication preferences: (1) driving discussions are emotionally charged; (2) context matters; (3) providers are trusted and viewed as authority figures; (4) communication should occur over a period of time rather than suddenly; and (5) older adults desire agency in the decision to stop driving.Various stakeholders involved in older driver safety should consider older drivers' perspectives regarding discussions about driving. Health care providers can respect and empower older drivers-and support their family members-through tactful communication about driving safety and mobility transitions during the life course.
| S-EPMC4842130 | biostudies-other
Project description:BackgroundThere is limited research of electronic tools for self-management for patients with chronic kidney disease (CKD). We sought to evaluate participant engagement, perceived self-efficacy and website usage in a preliminary evaluation of My Kidneys My Health, a patient-facing eHealth tool in Canada.MethodsWe conducted an explanatory sequential mixed-methods study of adults with CKD who were not on kidney replacement therapy and who had access to My Kidneys My Health for 8 weeks. Outcomes included acceptance (measured by the Technology Acceptance Model), self-efficacy (measured by the Chronic Disease Self-Efficacy Scale [CDSES]) and website usage patterns (captured using Google Analytics). We analyzed participant interviews using qualitative content analysis.ResultsTwenty-nine participants with CKD completed baseline questionnaires, of whom 22 completed end-of-study questionnaires; data saturation was achieved with 15 telephone interviews. Acceptance was high, with more than 70% of participants agreeing or strongly agreeing that the website was easy to use and useful. Of the 22 who completed end-of-study questionnaires, 18 (82%) indicated they would recommend its use to others and 16 (73%) stated they would use the website in the future. Average scores for website satisfaction and look and feel were 7.7 (standard deviation [SD] 2.0) and 8.2 (SD 2.0) out of 10, respectively. The CDSES indicated that participants gained an increase in CKD information. Interviewed participants reported that the website offered valuable information and interactive tools for patients with early or newly diagnosed CKD, or for those experiencing changes in health status. Popular website pages and interactive features included Food and Diet, What is CKD, My Question List and the Depression Screener.InterpretationParticipants indicated that the My Kidneys My Health website provided accessible content and tools that may improve self-efficacy and support in CKD self-management. Further evaluation of the website's effectiveness in supporting self-management among a larger, more heterogenous population is warranted.
| S-EPMC9388218 | biostudies-literature