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Open accessEditorialFirst published March, 2019pp. 3-4
Open accessResearch articleFirst published March, 2019pp. 5-6As an assistant professor of nursing and nurse in an emergency department, I offer my perspective on being a patient with cancer and the element of feeling vulnerable associated with an “insiders” viewpoint of the health-care system.
Open accessResearch articleFirst published March, 2019pp. 7-10This article offers a series of 3 vignettes exploring how art making has enabled me to understand my experience of the psychological and spiritual questions that have arisen throughout my diagnosis and subsequent treatment of multiple sclerosis (MS) in the private hospital system in Australia. The findings of the article indicate that the challenge to maintain a sense of identity that is separate to the experience of illness is critical for people who are living with MS and the language employed by health-care workers has a profound capacity to help or hinder this. Opportunities to make art in hospital supports the efficacy of prescribed medical treatments by enabling patients to exercise power in the midst of a process over which they have little or no control.
Open accessResearch articleFirst published March, 2019pp. 11-20Patient experience (PE) is recognized as a key component in the quality of health-care delivery. Public reporting of hospital, division, and physician-specific PE results has added to the momentum of adopting strategies to augment this metric of care. The Ottawa Hospital embarked on a journey to improve PE as a pillar of its quality improvement plan. This article demonstrates the efforts of a single surgery department from one large urban center to improve in-hospital PE in the rapidly changing environment of medicine and surgery. A multidisciplinary group within the department and a focus group of previous surgical inpatients were organized to address immediate challenges related to inpatient PE issues. We identified concrete strategies to optimize pain control, perceptions of patient respect and dignity, perceptions of surgeon availability, discharge medication understanding, and overall experience. Also, we identified a need in our department for timely patient feedback, improved communication styles in our staff and trainees, and an internal curriculum offering additional training for our staff and residents. We anticipate that the current results would be of significant interest to other departments wishing to optimize their PE profile as part of the ongoing quality improvement process at hospitals across North America.
Open accessOtherFirst published March, 2019pp. 21-23
Open accessResearch articleFirst published March, 2019pp. 24-32The risks to patient safety and quality of care faced by members of linguistic minority groups have been well-documented. However, little research has focused on the experience of official language minorities in Canada.
This multiple method study (online and paper-based surveys combined with semi-structured individual interviews with patients and interpreters-health navigators) explored the experience of minority Francophones living in 4 Canadian provinces.
Patients and interpreters-navigators described experiences where language barriers contributed to poorer patient assessment, misdiagnosis and/or delayed treatment, incomplete understanding of patient condition and prescribed treatment, and impaired confidence in services received. Reliance on Google Translate and ad hoc, untrained interpreters are commonly reported, in spite of evidence highlighting the risks associated with such practice.
Increased awareness that the risks of language barriers apply to official language minorities is essential.
Open accessResearch articleFirst published March, 2019pp. 33-40It is widely accepted that for HIV-positive persons on highly active antiretroviral treatment, high levels of adherence to treatment regimens are essential for promoting viral suppression and preventing drug resistance.
This qualitative study examines factors affecting the adherence to HIV/AIDS treatment among patients with HIV/AIDS at a local hospital in Malaysia.
The data from purposefully selected patients were collected by in-depth interviews using a pretested interview guide. Saturation was reached at the 13th interview. All interviews were audio-taped and transcribed verbatim for analysis using thematic content analysis.
Fear and stigma of perceived negative image of HIV diagnosis, lack of disease understating, poor support from the community, and perceived severity or the treatment side effects were among the reasons of nonadherence. Appropriate education and motivation from the doctors and reduction in pill burden were suggested to improve adherence.
Educational interventions, self-management, and peer and community supports were among the factors suggested to improve adherence. This necessitates uncovering efficient ways to boost doctor–patient communication and recognizing the role of support group for the social and psychological well-being of the patients.
Open accessResearch articleFirst published March, 2019pp. 41-45This article focuses on the patients’ acceptance of a subcutaneous injection device for patients with systemic lupus erythematosus, which in the upcoming years could be introduced beside the intravenous infusion of biological therapy. An online questionnaire was completed by 548 patients from different Italian regions. The preference for subcutaneous injection was 41.2%, for intravenous infusion was 36.9%, and 21.9% were uncertain. Patients with previous experience of biological therapies were less uncertain (
Open accessResearch articleFirst published March, 2019pp. 46-52Geographically localized care teams may demonstrate improved communication between team members and patients, potentially enhancing coordination of care. However, the impact of geographically localized team on patient experience scores is not well understood.
To compare experience scores of patients on resident teams home clinical units with patients assigned to them off of their home units over a 10-year period.
Patients admitted to any of the 4 chief resident staffed internal medicine inpatient service were included. Patients admitted to the house-staff teams’ home clinical unit comprised the exposure group and their patients off of their home units comprised the control patients.
Top-box experience scores calculated from the physician Hospital Consumer Assessment of Healthcare and Provider Systems (HCAHPS) and Press Ganey patient satisfaction surveys.
There were 3012 patients included in the study. There were no significant differences in experience scores with physician communication, nursing communication, pain, or discharge planning between the 2 groups. Patients did not report satisfaction more often with the time physicians spent with them on localized teams (48.6% vs 47.5%;
Patients cared for by geographically localized teams did not have better patient experience. Other factors such as physician communication skills or limited time spent in direct care may overshadow the impact of having localized teams. Further research is needed to better understand organizational, team, and individual factors impacting patient experience.
Open accessResearch articleFirst published March, 2019pp. 53-61Acute otitis media (AOM) is the most common pediatric bacterial ear infection, affecting up to 75% of children younger than 5 years. Despite the high incidence of AOM in children, the condition presents a number of challenges to parents. The objectives of this study were to describe parents’ experiences of taking care of a child with AOM and to identify their information needs to manage their child with AOM.
A qualitative, descriptive design was used to gain insight into information needs of parents’ of children with AOM. Participants were recruited from a specialized pediatric emergency department in a major Canadian urban center (Edmonton, Alberta). Individual semi structured interviews were conducted with 16 parents.
Seven major themes were identified and described: (1) frequency of AOM, (2) symptoms of AOM experienced by children and parents, (3) AOM symptom management strategies used by parents, (4) parent’s beliefs about AOM, (5) parent’s satisfaction with treatment prescribed by physicians, (6) the effect of AOM on family’s quality of life, and (7) parent’s information needs about AOM. Findings indicate that AOM has considerable negative outcomes for both children and families and that parents would benefit from having more evidence-based resources.
This study provides important information around parents’ experiences and information needs for pediatric AOM. Identifying parents’ information needs and developing innovative and communicatively responsive educational approaches for parents are warranted that reflect patient-centered nursing care.
Open accessResearch articleFirst published March, 2019pp. 62-67Research has shown that inpatients may not accurately report interacting with a pharmacist.
To determine accuracy of patients’ recollection of meeting with a pharmacist at 2 acute care teaching hospitals in Edmonton, Alberta, Canada.
Retrospective review of 391 surveyed patients discharged from April 2013 to March 2014. Responses to meeting a pharmacist (yes/no) were compared with 2 reference standards: pharmacist documentation in patient charts and pharmacist clinical workload data. Sensitivity, specificity, positive predictive, and negative predictive values were calculated.
One hundred ninety-five (49.9%) respondents reported meeting with a pharmacist. Of these, 71 (36.4%) had corresponding pharmacist chart documentation. Of the 196 respondents who reported not speaking with a pharmacist, 73 (37.2%) had documentation present. Compared with patient charts, sensitivity and specificity were 49.3% and 49.8%, respectively. Positive and negative predictive values were 36.4% and 62.8%, respectively. Similar results were seen in comparison with the workload data.
Patients often inaccurately reported meeting with a pharmacist in the acute care setting. The results are useful for pharmacist training, patient education, and for refinement of the current survey question.
Open accessResearch articleFirst published March, 2019pp. 68-71Chronic skin conditions can have a profound impact on people’s lives, both physically and psychologically, and may predispose to mental health disorders. Providing sufferers with appropriate psychological support is important.
In this study, we captured the views of people suffering from a chronic skin condition who were attending the “Skin Matters” conference, held on 20 May 2017, in London. Methods: Delegates were provided with a 5-point questionnaire to complete. Questions related to the impact of their chronic skin condition on their life, the nature of any psychological support they had found helpful and whether they felt they could benefit from greater support in managing their condition.
59% of the delegates completed the questionnaire. The survey results showed that skin conditions can have an impact of many areas of daily living as well as on mental well-being. The most popular source of psychological support was the Internet. The majority of survey participants felt they would benefit from increased psychological support in managing their condition.
In the United Kingdom, there is a need to improve the availability of resources for people/patients with skin conditions in order to provide better support.
Open accessResearch articleFirst published March, 2019pp. 72-80Patient experiences with the health-care system are increasingly seen as a vital measure of health-care quality. This study examined whether workplace social capital and employee outcomes are associated with patients’ perceptions of care quality across multiple clinic sites in a diverse, urban safety net care setting. Data from clinic staff were collected using paper and pencil surveys and data from patients were collected via a telephone survey. A total of 8392 adult primary care patients and 265 staff (physicians, nurses, allied health, and support staff) were surveyed at 10 community health clinics. The staff survey included brief measures of workplace social capital, burnout, and job satisfaction. The patient-level outcome was patients’ overall rating of the quality of care. Factor analysis and reliability analysis were conducted to examine measurement properties of the employee data. Data were aggregated and measures were examined at the clinic site level. Workplace social capital had moderate to strong associations with burnout (
Open accessResearch articleFirst published March, 2019pp. 81-86In response to reported difficulties in selecting a Medicare Part D prescription drug plan, we designed a patient-centered online Part D plan selection tool (CHOICE1.0) to simplify the selection process and to provide personalized, expert recommendations.
This ethnographic comparative usability study observed 44 patients using the first version of the tool during Medicare 2016 Open Enrollment. Participants were observed as they chose their drug plan using Medicare.gov and 1 of 3 versions of CHOICE1.0 that varied in amount of expert guidance. Descriptive statistics were used to analyze exit survey data. The observations were video-recorded, and field notes were analyzed thematically.
Participants were significantly more satisfied with CHOICE1.0 for choosing a plan, understanding information, and ease of use compared to Medicare.gov. Those using expert versions of CHOICE1.0 were more likely to indicate their intention to switch plans than those using Medicare.gov, though they wanted to know the source and content.
The more patient-centered prescription drug choice tool improved user experience and enabled users to choose plans more consistent with expert recommendations.