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Are mobile health apps and digital interventions improving adherence?

Are mobile health apps and digital interventions improving adherence? | Patient Self Management | Scoop.it

Mobile and digital health’s potential to help bring about healthy behavior changes has led a number of companies to target the problem with new connected devices, applications, and services. Some of these have claimed to be highly effective: MediSafe recently stated that their app raised users’ adherence rate to 81 percent over the course of its first eight weeks that it was made available, and Vitality GlowCaps once reported pushing adherence rates to as high as 98 percent, both well above the World Health Organization average of 50 percent. NEHI has stated that digital health offerings similar to these have considerably improved adherence, but the market penetration for these tools is still low.

 

The challenge for these companies is not just to develop an effective product, but also to figure out who will pay for it. That means addressing the sticky question of whose problem med adherence really is.

 Patients don’t take their medication for a number of reasons. Forgetfulness is one, particularly in chronic disease patients who have a large regimen of pills to keep track of and in elderly patients who may have poor memories or become confused easily. But other patients don’t take their meds for psychological reasons: some patients “feel fine” and skip a drug, some are concerned about real side effects. Some, according to NEHI Senior Health Policy Associate Nick McNeill, are concerned about imagined side effects. Finally, many patients stop taking medications because they simply can’t afford the co-pay. This, of course, is not a complete list but it does include some of the more commonly referenced reasons. Digital health could play a role in resolving some of them.


Via Andrew Spong
rob halkes's insight:

Indeed, it is due to a lot if still unknown and  scarcely reserached personal reasons that influence adherence to therapy. More must be done!

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Andrew Spong's curator insight, January 21, 2013 12:08 PM

Click on the title link above to read the full article on mobihealthnews

Jenni Lawrence's comment, January 22, 2013 10:46 PM
cost of taking now versus BIGGER costs of not taking now.... hmmm... seems like a no brainer to me!
Patient Self Management
patient self management, compliance, adherence, patient coach, patient monitoring, patient empowerment, shared decision making, patient education, patient counseling, participatory care
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Wolters Kluwer | Press | News | Survey: Americans Want Greater Control Over Their Own Healthcare

Wolters Kluwer | Press | News | Survey: Americans Want Greater Control Over Their Own Healthcare | Patient Self Management | Scoop.it
Wolters Kluwer is a market-leading global information services and publishing company focused on professionals.

(December 12, 2012)  — 

Philadelphia, PA (December 12, 2012) – According to a new Wolters Kluwer Health survey, 80 percent of consumers believe the greater “consumerization” of healthcare – or the trend of individuals taking a greater and more active role in their own healthcare – is positive for Americans. Survey data suggests many Americans feel that a greater role in their care is not only good, but necessary, with 86 percent of consumers reporting that they feel they have to take a more proactive role in managing their own healthcare in order to ensure better quality of care.

 

Most consumers also say they feel prepared to take on a greater role in managing their own healthcare, with 76 percent reporting that they have the information and tools to take a more proactive role in healthcare decisions ranging from choosing healthcare providers to researching treatment options. Despite feeling prepared, only 19 percent report that they have their own electronic Personal Health Record (PHR).

[..]

“With greater responsibility placed on patients to take a role in their own care, it’s essential that consumers have access to evidence-based tools and resources to make informed decisions about their care in partnership with their healthcare providers,” said Dr. Linda Peitzman, Chief Medical Officer, Wolters Kluwer Health. “Access to research-based medical information not only can positively impact quality of care, but it also can lead to improved doctor-patient communication and relationships.”

Survey findings showed that the notion of the “patient experience” is also gaining significance for many Americans. Three in ten adults (30 percent) want their patient experience to be the same as any other customer experience they have – such as shopping, hotel and travel experiences – complete with choices and control.

[..]


See report here


rob halkes's insight:

Already at the end of 2012 this survey was completed about the consumerization of health care. See the report here .

Now, in 2014, we can state that the trend is persevering.

Ehealth is now no more option, it is a must tp adapt to patients' wishes!

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Co-Creation in Health Care

Co-Creation in Health Care | Patient Self Management | Scoop.it

Experience co-creation in health care is an effective method to innovate value to patients in a personalized way, in collaboration with all relevant stakeholders.
It is intended to benefit patient...

rob halkes's insight:

Co-creation between all stakeholders in health care is certainly necessary to create sound and proper patient journeys in ehealth.


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Effects of diabetes self-management programs on time-to-hospitalization among patients with type 2 diabetes: A survival analysis model

Effects of diabetes self-management programs on time-to-hospitalization among patients with type 2 diabetes: A survival analysis model | Patient Self Management | Scoop.it

Patient Education and Counseling, Volume 95, Issue 1, Pages 111-117, April 2014, Authors:Omolola E. Adepoju; Jane N. Bolin; Charles D. Phillips; Hongwei Zhao; Robert L. Ohsfeldt; Darcy K. McMaughan; Janet W. Helduser; Samuel N. Forjuoh

Abstract Objective

This study compared time-to-hospitalization among subjects enrolled in different diabetes self-management programs (DSMP). We sought to determine whether the interventions delayed the occurrence of any acute event necessitating hospitalization.

Methods

Electronic medical records (EMR) were obtained for 376 adults enrolled in a randomized controlled trial (RCT) of Type 2 diabetes (T2DM) self-management programs. All study participants had uncontrolled diabetes and were randomized into either: personal digital assistant (PDA), Chronic Disease Self-Management Program (CDSMP), combined PDA and CDSMP (COM), or usual care (UC) groups. Subjects were followed for a maximum of two years. Time-to-hospitalization was measured as the interval between study enrollment and the occurrence of a diabetes-related hospitalization.

Results

Subjects enrolled in the CDSMP-only arm had significantly prolonged time-to-hospitalization (Hazard ratio: 0.10; p=0.002) when compared to subjects in the control arm. Subjects in the PDA-only and combined PDA and CDSMP arms showed no improvements in comparison to the control arm.

Conclusion

CDSMP can be effective in delaying time-to-hospitalization among patients with T2DM.

Practice implications

Reducing unnecessary healthcare utilization, particularly inpatient hospitalization is a key strategy to improving the quality of health care and lowering associated health care costs. The CDSMP offers the potential to reduce time-to-hospitalization among T2DM patients.

rob halkes's insight:

Focused and systematic self management programs work! Hopitalization maybe prevented. Inspiring reading.

ALSO: the image I used came from the "Arthritis Ireland" Project: "the case for self management" see here: http://bit.ly/1gKszKV


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Web 2.0 Chronic Disease Self-Management for Older Adults: A Systematic Review

Web 2.0 Chronic Disease Self-Management for Older Adults: A Systematic Review | Patient Self Management | Scoop.it
Web 2.0 Chronic Disease Self-Management for Older Adults: A Systematic Review


Background: Participatory Web 2.0 interventions promote collaboration to support chronic disease self-management. Growth in Web 2.0 interventions has led to the emergence of e-patient communication tools that enable older adults to (1) locate and share disease management information and (2) receive interactive healthcare advice. The evolution of older e-patients contributing to Web 2.0 health and medical forums has led to greater opportunities for achieving better chronic disease outcomes. To date, there are no review articles investigating the planning, implementation, and evaluation of Web 2.0 chronic disease self-management interventions for older adults.
Objective: To review the planning, implementation, and overall effectiveness of Web 2.0 self-management interventions for older adults (mean age ≥ 50) with one or more chronic disease(s).
Methods: A systematic literature search was conducted using six popular health science databases. The RE-AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) model was used to organize findings and compute a study quality score (SQS) for 15 reviewed articles.
Results: Most interventions were adopted for delivery by multidisciplinary healthcare teams and tested among small samples of white females with diabetes. Studies indicated that Web 2.0 participants felt greater self-efficacy for managing their disease(s) and benefitted from communicating with health care providers and/or website moderators to receive feedback and social support. Participants noted asynchronous communication tools (eg, email, discussion boards) and progress tracking features (eg, graphical displays of uploaded personal data) as being particularly useful for self-management support. Despite high attrition being noted as problematic, this review suggests that greater Web 2.0 engagement may be associated with improvements in health behaviors (eg, physical activity) and health status (eg, HRQoL). However, few studies indicated statistically significant improvements in medication adherence, biological outcomes, or health care utilization. Mean SQS scores were notably low (mean=63%, SD 18%). Studies were judged to be weakest on the Maintenance dimension of RE-AIM; 13 reviewed studies (87%) did not describe any measures taken to sustain Web 2.0 effects past designated study time periods. Detailed process and impact evaluation frameworks were also missing in almost half (n=7) of the reviewed interventions.
Conclusions: There is need for a greater understanding of the costs and benefits associated with using patient-centered Web 2.0 technologies for chronic disease self-management. More research is needed to determine whether the long-term effectiveness of these programs is sustainable among larger, more diverse samples of chronically ill patients. The effective translation of new knowledge, social technologies, and engagement techniques will likely result in novel approaches for empowering, engaging, and educating older adults with c

rob halkes's insight:

Great inspiring review of self management interventions using web20 applications. Surely more research is needed. But let it inspire you to contribute! 

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Health apps: where do they make sense? A patient opinion-informed white paper

Health apps: where do they make sense? A patient opinion-informed white paper | Patient Self Management | Scoop.it

Conclusions of the first ever cross-stakeholder, pan-european seminar on health apps, held at the King's Fund on 28 October 2013.

 

The five key messages:

 

1. Overhauling healthcare systems–making them patient-centric

2. Engaging doctors in the prescribing of health apps
3. Overseeing quality standards for health apps
4. Ensuring that health apps remain of a high standard throughout their lifetime
5. Considerations for policymakers wishing to oversee health apps


Via Andrew Spong
rob halkes's insight:

Great Read!

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Andrew Spong's curator insight, March 18, 5:17 AM

My POV:

 

1. Lip-service has been given to this idea since time immemorial, but there are few examples of such change having not only been instantiated, but maintained, and used to drive strategic direction. This is a systemic problem which I don't think will be resolved until we accept that 'reskinning' existing structures is inadequate to the needs of truly patient-centred healthcare design.

 

2. Unenforceable, but necessary. A paradox that may only be resolved through cross-constituency digital peer-review (imagine the degree of insight and involvement if there were a '#FOAMed meets #bcsm' for every disease area)

 

3. See above. 'Regulation' as we understand it will neither be viable, nor enforceable. Whether we want a 'top layer' of heavy-hitting health faculty acting as a secondary filter before content enters the App Store (Apple) and Play (Google) is another question. I'm not sure if it's even a good idea (re-replacing 'evidence with eminence' again) unless it's largely automated using a Watson-like AI with a complete picture of the existing gold standard in all evidence.

 

4. Predicated upon the expectation that they're of a high standard at launch, which simply isn't the case.. The majority of health-related content available as apps is of low quality and relevance.

 

5. Re. the first paragraph of the synopsis of this section: 'The consensus at the seminar was that the adoption of smartphone technology will not create health inequalities, but rather can increase healthcare sustainability'. I strongly agree with this line of reasoning, and feel that the 'digital divide' debate needs to be answered once and for all.

 

My answer to this last point: principally, this is a period of transition, and no plans should be made to accommodate perceived (and usually unsubstantiated) inequalities in terms of access to health information which will diminish over time -- although NB levels of health literacy are another matter. Where digital exclusion exists (and such conclusions often overlook the 'one step removed' access to digital health via family members, friends, and carers) the savings made from the efficient implementation of lower-cost digital health initiatives (and there really should be some; if there aren't, questions need to be asked about the organisation under review) should be reinvested in targeting hard-to-reach communities in an offline setting.

Marisa Maiocchi's curator insight, March 21, 2:55 PM

Aportes y conclusiones del primer seminario pan-europeo sobre apps de salud. Muy interesante.

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Why I tweet: A patient advocate view

Why I tweet: A patient advocate view | Patient Self Management | Scoop.it
Who would have thought that this tiny aperture -- a mere 140 characters -- could connect me with so many smart, feisty people?

...

Since 1992, I have advocated for all of us to have the information, support and guidance we need to act to improve our health and get the most from our health care. I believe — and there is evidence to back me up — that we do better when we participate in our care to the extent we are able with as much knowledge about what might work that we can absorb.

As someone who has been/is being treated for five different types of cancer, I am familiar with many of the challenges we face in getting the most out of our health care. We not only need to know about our specific diseases and treatments and what we can do about them, but we also need to know something about how our care is organized and about changes in general health knowledge and medical practice that affect how we make use of the resources and services available to us. Then we have to act on our own behalf or on behalf of our child, partner, spouse or parent. The organization I direct, the Center for Advancing Health, has mapped out the tasks that are now ours — the many actions we must take to find good health care and benefit from it.

Every weekday, I tweet a carefully chosen stream of new evidence, analysis and commentary that covers all the health and health care angles that we — sick or well — might need to know about. I tweet material from major news outlets, peer-reviewed literature, blogs and magazines in the belief that thoughtful consideration of emerging information and understandings about health and health care will serve us well.

Here’s why I tweet what I tweet:

  • It has never been more important for us to be well-informed about so many aspects of health care — not just our complaint of the moment. Otherwise, when we are passive recipients of care, we risk being on the receiving end of medical errors, spending money on unnecessary tests, receiving suboptimal care or simply not knowing how we can best help ourselves. I aim to tweet what we need to know.
  • Evidence has never been more important. Especially considering media reports that much of the care we receive may not be consistent with evidence of what is currently deemed most effective. Combined with the rapid pace of new findings, understanding the facts relevant to your situation can be intimidating to patients and health professionals alike. Plus, it’s time-consuming for us to sort out solid information from broad assertions and slick advertisements, so I aim to tweet evidence worth noting, with the understanding that next week’s evidence may reverse what we know today.
  • Finding high-quality analysis and commentary that is relevant to the decisions we must make about our health and care every day is a bear. I know. I wouldn’t be traipsing through 40+ different sites every day in search of the best pieces if they were located in one place. I aim to tweet links to useful, diverse analyses and findings.
  • Understanding health and health care is not just a matter of digesting new facts. It also includes considering implications of those facts and different perspectives on policies so that the facts have context and meaning. I aim to include articles that tweak easy assumptions, shed light in dark corners and sometimes make me smile.
  • Lastly, it’s funner than heck to do this. I have an insatiable taste for gossip, a fascination with trying to figure out what we really need to know to care for ourselves, a long memory for ineffective-but-nevertheless-repeated health care foibles and an impulse toward snarkiness that occasionally breaks through. Spending a couple of hours each day trawling online for new findings, blogs, articles and essays that I think you might find interesting is a great way to start the day. ...
rob halkes's insight:

Thanks Jessie for sharing this. The only thing I can prudently verb, is: I wished doctors would do so, like you do.. ;-)
But I guess they don't .. ...

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It's Not Easy to Engage Patients — Even for ACOs

It's Not Easy to Engage Patients — Even for ACOs | Patient Self Management | Scoop.it

by Molly Gamble  - [ See my comment, if you want it quickly read - but that would be a shame ;-) ]
Patient-centered care is a cornerstone of any accountable care organization, but creating or joining one doesn't necessarily make patient engagement any easier. In the world of healthcare business, patient engagement may sound like a "soft" concept, but its difficulty is nothing to underestimate.

David Muhlestein, PhD, director of research at Leavitt Partners in Salt Lake City, says a minority of patients want to be engaged with their care teams in actively managing their healthcare. The high majority — likely approaching 70 percent — want to turn their care over to their physician and have them take the reigns. The rest of patients do not want to share decisions about their healthcare with physicians at all — they prefer to decide on their own.

"ACOs are finding it's really hard to get people engaged," says Dr. Muhlestein. "Some are proactive or are really trying to engage patients in different ways, but they're not particularly seeing more success than anyone else."

What is working for ACOs' patient engagement? What are the biggest roadblocks? As it turns out, there are several definitions of patient responsibility, high-deductible health plans are bad news for accountable care and no ACO provider will be successful on a high horse.

Seven degrees of engagement
There are numerous buzzwords for patient responsibility — patient engagement, accountability, skin in the game. It's easy to lump these ideas together as synonymous, but Dr. Muhlestein says there are some nuances.

For example, patients and physicians may arrive with different expectations for patient engagement. Patients see it as shared decision-making, or talking to a physician before a decision is made about their treatment to learn about the pros and cons, then making the ultimate decision in conjunction with the physician. It's a behavior largely reserved for the visit to the physician.

Physicians, on the other hand, see engagement as active condition management. This includes lifestyle changes, adherence to medications and regular dialogue with the care team to ensure the care plan is going smoothly. Essentially, this version of patient engagement involves the patient taking on more responsibilities that traditionally belonged to clinicians and carrying them out between physician visits.

People who have used accountants to complete income taxes may see where patients are coming from. Instead of doing a few tasks on a daily basis, many people find it easier to drop off their financial paperwork and receipts at the end of the year and let someone else do the math. The same is often true for patients' expectations for healthcare.

"You want to say, 'Here, you deal with this. I'll come back next month and you'll tell me how to change the doses of my meds,'" says Dr. Muhlestein.

How having "skin in the game" could muddle accountable care
There's another shade of patient responsibility, one that is a little greener in hue. More patients are taking on more financial responsibility for their healthcare. Recent years have brought a boom of high-deductible health plans, which cut businesses' health benefit costs by shifting more responsibility onto their employees. This is not the best news for people trying to advance accountable care. Some ACO leaders simply call these health plans outrageous, even immoral.  

"It's something we're concerned about," says Marcia Delk, MD, chief quality officer with Marietta, Ga.-based WellStar Health System, a five-hospital system participating in the Medicare Shared Savings Program. Dr. Delk spoke about the trend more generally, as high deductibles don't pertain to Medicare beneficiaries. "Those individuals with more of a responsibility to their bills are very price sensitive to whatever healthcare they're buying." And this sensitivity extends to basic preventive care — a huge component of population health — that is covered by their plans.

A 2012 study conducted by Rand Corp., Towers Watson and the University of Southern California examined families' use of care in the first year after switching from traditional plans to high-deductible health plans. These families spent, on average, about 14 percent less on their healthcare than those enrolled in traditional plans. But they also cut back on beneficial preventive services — such as cervical and colorectal cancer screenings, mammograms, and blood tests for glucose and lipids — even though most of these preventive services are covered under consumer-directed plans…
Much like the financial case providers must make for investments in population health management — linking initial costs to long-term gains — physicians and care teams may need to take a similar approach with their patients. Robust communication and patient education can help them understand the value of their vaccinations, mammograms and other preventive measures, and how these are not the measures to skimp on.

"If we engage patients properly and work with them to understand the benefit of taking care of a chronic condition, or getting a colonoscopy, and how that will reduce costs later on, it can work," says Dr. Delk.

Reaching instead of preaching
That seems to be the main job description for ACOs today — finding what works.

Conclusion
The normal fee-for-service environment does not have financial rewards for patient care coordination or care management programs. Even though ACOs are one of the most progressive steps toward pay-for-performance reimbursement, joining one doesn't necessarily provide direct reimbursement for patient education and engagement.


rob halkes's insight:

This blog describes how patient centered care and empowerment of patients is interpreted not so much as facilitating patients to take responsibility for their own care for health, supporting them to make right decision by dialogue about it and helping them to implement behavioral consequences in daily practice/therapy, but to shift responsibility all together to the patient, and just take only financial consequences ahead of whatever patients will do. As if they confront patients with what they really like to do: “Never mind me anymore, you just have to see by yourself now. And, in any case I’ll shift the financial consequences already to you to begin with!”
Indeed, for much of new approaches to design patient care we still have to find out. But that is the right attitude to invest in lowering cost for the future.
Self management in patient care is not a miracle to health care costs it is just the right journey to better times!

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rob halkes's comment, January 31, 4:08 AM
Thx all for sharing!
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ON medical consult: "Golf, Death, Sharing and Caring" - Howard J. Luks, MD

ON medical consult: "Golf, Death, Sharing and Caring" - Howard J. Luks, MD | Patient Self Management | Scoop.it

As I sat next to him, and now in a voice confident and ringing with anticipation, Mr A explained in painstaking detail how he determined which approach shot to hit to the 2nd green on the Black Course at Bethpage State Park.

Only 10 minutes earlier when Mr A and I first met he was weary, his face was drawn, and the sound of the aortic balloon pump keeping him alive made it nearly impossible to hear him.

Sitting down, which would seem like one of the simplest things to do, is the least practiced of five communication skills for doctors that Lenore would have endorsed and that research has shown can make a big difference in patient satisfaction.

“5 Simple Habit to Help Doctors Connect with Their Patients”

When my grandmother was caring for my ill grandfather — she expressed neverending confidence in his physician.  As a physician in training I was very interested about the qualities she saw in him that made her so confident that he was in fact the best doctor for her husband.

He talks to us.  He sits with us.  He takes time out of his busy day to let us know that he cares…

My grandfather passed away not too long after that discussion.  Sadly it was likely that very same physicians fault.  But no one needed to now that… my grandmother’s confidence didn’t wane through his last dying days.

(read on at the original blog by Howard..!)

rob halkes's insight:

On Medical Consult: great insight and vision on how consults might become truly interactive dialogues. Thanks Howard!

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Five Things New Patients Think Which Surprise Me

Five Things New Patients Think Which Surprise Me | Patient Self Management | Scoop.it

     Patients now often enter a physician’s office with preconceived notions. All the parties involved are cognizant of one thing: time is limited. The patient is hoping their issue is addressed he patient is hoping their issue is addressed (hopefully, the provider often fears it is not more than one), the physician hoping that the right targeted information is provided.  These desires are commonly not met by either side. Should there be ‘sides’ to healthcare?  How did this inherently adversarial relationship develop before the parties have even met? In an  earlier postI discuss the importance about navigating the healthcare system.  I would like to discuss here some observations I have made both in practice and as a caregiver for my mother on the initial office visit. They address my sensitivity to issues which are viewed by others who are resigned to a new status quo and accept them as part of healthcare. Perhaps digital health technologies facilitating communication among patients and providers will help in these regards.

1.    Patients see answering their questions as a value added service.  I am amazed at “Is it OK if I ask a question?”  To their amazement, my pat answer is “This is what I am here for.”  Every encounter is concluded by asking “Do you have any (or other) questions?” The look of satisfaction after that is the only thing I need to propel me to my next patient with a sense of satisfaction and purpose.

2.    Patients think they need to provide a diagnosis instead of seeking one.  I have heard countless patients seeking my help (either via referral by another physician or self-referred) that they are sorry they don’t know a diagnosis for the complaints which have prompted my visit. My philosophy is that a patient is only responsible for describing symptoms.  Most physicians are familiar with Sir William Osler, a great pioneer in medicine, who said “Most times it is the patient who will furnish the diagnosis.”  What he meant was that the patient’s narrative, NOT a specific diagnosis would provide adequate information to make said diagnosis. While it is not as easy today, given significant therapeutic implications not present in Osler’s time, the patient’s story remains critical to focusing future investigation and questioning. I allow the patient to furnish the whole story without interruption. In the case of no specific diagnosis found for a non-serious condition, I emphasize that it is just as important in knowing what it ISN’T as what it is, and that this is not a denial of their symptoms.  I encounter this often facing patients with palpitations.

3.    Patients smile when I tell them that I dispense medications and suggest tests on a minimal basis. Most patients, contrary to many providers’ impression, do not seek or desire a pill, tests or procedures.  Certainly they cannot be avoided in all circumstances. Initially, they want to know if the condition is (or potentially) serious, and why each therapy, test, or procedure is prescribed. Explanations go a long way. Often communication with other providers (especially regarding side effects of meds prescribed by others) is critical. I tell patients that my goal is to decrease medication use, not to increase it. I find that relatively healthy 90 year olds are on minimal medications and tell them that it is in part for this reason that they are doing relatively well. Ordering tests for defensive medicine purposes is largely unnecessary and many do not fall into accepted practice guidelines. Good patient relationships are fundamental to decreasing liability concerns. Minimizing interventions are both important in this regard and appreciated by patients as a sign of patient advocacy.

4.    Patients are relieved when I acknowledge the importance and intent of caregivers.  Many patients are embarrassed when significant others or other caregivers accompanying them to either ask questions, take notes or corroborate the narrative.  I take time to dispel any doubt about the importance of that person. I first ask for the relationship of the person and if it is OK to share all of my thoughts with that person. The extent of caregiver support might very well affect the type of treatment plan I recommend or the need to contact that person to discuss the shared decision plan.

5.    Patients are surprised when I tell them that old age is not a diagnosis.  While many diseases are diseases of old age, a patient’s age itself is not a disease. Someone presenting with fatigue due to anemia should certainly not be written off as having ‘anemia of old age.’  I am not advocating exhaustive workup of elderly patients, merely stating that a discussion regarding shared treatment decisions needs to take place.  Discussions surrounding advanced directives should also include how far one would like to go in testing and therapeutic procedures. This might not preclude an otherwise healthy elderly patient from undergoing a workup for a problem impairing quality of life.

rob halkes's insight:

An informative story told from the perspective of a well intended physician. Yes, indeed there's a lot within the doctor - patient communication that needs to be optimalized to get a satisfactory, effective (and efficient) dialog. But remember, years of socializiation, taken for granted societal positions, authority perceptions, social psychological status, demands of well mannered behaviourr and all, stand still in the way, of course not intentional, but they do. It might be worth studying how we can mend these issues better..

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Q&A: Patient consent for treatment

Q&A: Patient consent for treatment | Patient Self Management | Scoop.it

MDU adviser Dr Caroline Fryar answers common GP questions on gaining and recording patient consent

GPs can leave themselves vulnerable to criticism if they fail to take proper consent, or fail to properly record the consent process. In order to properly consent to treatment, patients must be given enough information to make an informed choice, so the explanation given to and understood by the patient is crucial.

Here we address some of the common questions GPs ask about obtaining valid consent, providing information about risks and getting consent from patients who lack capacity.

E.g.:

- How can I ensure consent is valid?

The GMC makes it clear in its publication Consent: doctors and patients making decisions together (2008) that it is the responsibility of the doctor undertaking the investigation or providing the treatment to discuss it with the patient. This means explaining to patients in non-technical language the nature, purpose and risks of the proposed procedure. If the treatment is difficult to understand, it may be helpful for you to use drawings, diagrams and models. If necessary, an interpreter should be there to make sure the explanation is given in a language the patient understands.

You may ask patients to sign a consent form for certain procedures such as minor surgery, but this is of secondary importance to the consent discussion, although it may be useful evidence if a complaint or claim arises.

- Do I have to get consent for every procedure?

- At what point should I get consent?

- Who can obtain consent?

- What is the medico-legal definition of consent?

- What risks do you need to warn the patient about?
- How can I help patients to make a decision? Should a GP try to make it easier for patients to make decisions for their care, e.g by using simple language?
- HOw can I asess whether the patient has capacity? ...

etc.etc...

rob halkes's insight:

Is "patient consent" enough to state that doctor and patient make joint decisions? (Compare with this phrasing: "when the patient has consented to a certain procedure or activity, are doctor and patients making shared decisions?")

Is patient's consent satisfactory to conclude an optimal relationship between doctor and patient is present conducive to optimal health outcomes?

This is all well intended, of course. Still: although it is, as is written, about doctors and patients making decisions together. But in the initating of these Q&A's, isn't there something odd?

Are legal interests of doctors being put above patients's interests for well taken care? Is development of an optimal relationship between caregiver and -taker paved by the concept of consent? is it that easy?

OMG, we are still far away, aren't we? Or do youthink differently?

 

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Information rights for patients in Germany

Information rights for patients in Germany | Patient Self Management | Scoop.it

Das Patientenrechtegesetz: Rechtliche Hinweise und Empfehlungen für Ärzte und Psychotherapeuten

Das Patientenrechtegesetz ist seit Februar 2013 in Kraft. Die Einführung der neuen Paragrafen 630a bis 630h des Bürgerlichen Gesetzbuches (BGB) war bundesweit Thema in den Medien. Trotzdem wirft das Gesetz immer wieder Fragen auf: Welche zusätzlichen Pflichten haben niedergelassene Ärzte und Psychotherapeuten jetzt beim Dokumentieren der Behandlung? Dürfen Pati- enten auch außerhalb der Sprechzeiten Einsicht in ihre Akte verlangen? Wie viel kann für eine Kopie in Rechnung gestellt werden? Wer darf die Akte ei- nes verstorbenen Patienten einsehen? – Mit diesen und ähnlichen Anfragen können auch Sie jetzt verstärkt konfrontiert sein.


The Law on Patients' rioghts in Germany: Legal guidelines and advices for physicians and fysiotherapists. 

The law on patients' rigths is set in force since February 2013. The introduction of new paragraphs 630a to 630h of the citizens rights book has been an issue in the several states of Germany.  Nevertheless, the law raises ever new questions: what new obligations are added now to the "niedergelassene" physicians ans physiotherapists regarding documentation of their treatments? Can patients have also right of view/inspection of their records outside of consultation times? How much could one charge for copies of records? Who could see the records of a deceased patient? You could be confronted with such questions as well. ...


Read further, but in German

rob halkes's insight:

Very, very good that patients' rights are documented lawfully! It will help to rearrange respective actions and services in practice of care and it 'll be transparant to all participants. Every country should look into this! So, it might well be a Human right.

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Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease - Publications — NEHI – A national health policy institute

Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease - Publications — NEHI – A national health policy institute | Patient Self Management | Scoop.it

Publication Date: August 12, 2009

In its new research brief, "Thinking Outside the Pillbox," NEHI addresses the root causes of poor patient medication adherence - a significant contributor to overall health care waste - and offers promising solutions to improve adherence, particularly among chronic disease patients.

 

See pdf of full report

rob halkes's insight:

t is a little bit dated, yes. But I haven't seen yet a more clearly, rightly conceived overview of the issue of patient adherence. Since 2009, we have moved on and know more of patient adherence and (self)  support (on line). But his pictures a complete picture to ground it all!

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rob halkes's curator insight, October 16, 2013 6:50 AM

It is a little bit dated, yes. But I haven't seen yet a more clearly, rightly conceived overview of the issue of patient adherence. Since 2009, we have moved on and know more of patient adherence and (self)  support (on line). But his pictures a complete picture to ground it all!

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Infographic: Patients Want Access To Their Electronic Medical Records

Infographic: Patients Want Access To Their Electronic Medical Records | Patient Self Management | Scoop.it
84 percent of US consumers believe they should have full access to their electronic medical records while only a third of physicians (34 percent) share this belief, according to an Accenture survey.
rob halkes's insight:

Good to se that patient empowerment is growing!

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"Patient Engagement" in Health Care: Literature Review | Journal of Participatory Medicine

"Patient Engagement" in Health Care: Literature Review | Journal of Participatory Medicine | Patient Self Management | Scoop.it
The term "patient engagement" is at risk of becoming a vague buzzterm, as it lacks a shared definition. This paper aims to pinpoint the key conceptualizations of "patient engagement" from recent academic literature, in order to deepen understanding of the term.
rob halkes's insight:

Read it - and think about what you  "mean" when you talk about "patient angagement" - Informative!

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" Flip the Clinic " | Maybe we all "flip" ..

" Flip the Clinic " | Maybe we all "flip" .. | Patient Self Management | Scoop.it

"How "Flipped" is your health practice?"

Flip the Clinic is a new Robert Wood Johnson Foundation project to re-imagine the medical encounter between patients and care providers.

What Exactly is Flip the Clinic?

Our goal is not only to create a specific set of practices that will improve the medical encounter, but also to inspire others to invent new ways to get more out of the clinic visit, too.

The first batch of resources for patients and providers launched in early 2014. But we’re not stopping there. The future of Flip the Clinic will be built from patient, care provider, and administrator input and ideas; it will be built from the advice of those willing to try something bold. We hope that FliptheClinic.org will serve as a hub for innovative ideas already happening as well as a clearinghouse for what works and what doesn’t in the doctor-patient encounter. Flip the Clinic is an ongoing conversation, powered by your participation.


The traditional doctor’s visit is ripe for reinvention—both because it is such a valuable interaction, and because we know there are ways to make it better.

We believe that new tools, technologies, and strategies can empower people to be more informed and more engaged when they walk into the doctor’s office and better equipped to improve their health when they walk out the door. And we believe that doctors, nurses, and other care providers can improve the ways they communicate and engage with patients during visits. We believe they can take advantage of new tools for monitoring, supporting, and connecting with their patients outside of the office, too.

We think that by tapping into these strategies, we could to turn the provider-patient interaction on its head—and promote better, more meaningful relationships while doing so.



rob halkes's insight:

"Flip the Clinic" , or perhaps: Flip health care, seems to grow a new community/movement around better interaction between doctors and patients. A lot to be said of course, but I like the very attention to behaviour of the two parties here.

It will touch all issue of care, like interaction, communication, treatment, building and business. But one must go one stap at a time. I like it because it enters the controversial arena of medine and care interaction. The "flips" are very much to the point in my opinion, and they will draw attention to where it should be. It is just the other goal of disrupting care, not just the Health20 technology, but also engaging and participating care.

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Addressing health literacy through clear health communication: A training program for internal medicine residents

Addressing health literacy through clear health communication: A training program for internal medicine residents | Patient Self Management | Scoop.it
Patient Education and Counseling, Volume 95, Issue 1, Pages 76-82, April 2014, Authors:Jamie A. Green; Alda Maria Gonzaga; Elan D. Cohen; Carla L. Spagnoletti


Abstract 

Objective

To develop, pilot, and test the effectiveness of a clear health communication curriculum to improve resident knowledge, attitudes, and skills regarding health literacy.

Methods

Thirty-one internal medicine residents participated in a small group curriculum that included didactic teaching, practice with a standardized patient, and individualized feedback on videotaped encounters with real patients. Outcomes were assessed using a pre-post survey and a communication skills checklist.


Results

Mean knowledge scores increased significantly from 60.3% to 77.6% (p<0.001). Residents also reported increased familiarity with the concept of health literacy (mean response 3.2 vs. 4.5 on a 5 point scale), importance placed on health literacy (4.2 vs. 4.9), frequency of considering health literacy in patient care (3.3 vs. 4.0), and confidence in communicating with low literacy patients (3.3 vs. 4.1) (all p<0.001). Use of plain language increased significantly from 33% to 86% (p=0.023). There were nonsignificant increases in the use of teach-back (0–36%, p=0.116) and encouraging questions (0–14%, p=0.502).


Conclusion

Training in clear health communication improves resident knowledge, attitudes, and skills regarding health literacy.

Practice implications

The increased use of clear health communication techniques can significantly improve the care and outcomes of vulnerable patients with limited health literacy.


rob halkes's insight:

Good to have prove that health literacy is crucial and practically teachable to medicine residents. One just has to to do it..;-)

Quote from the article: "A key strategy to reduce the impact of low health literacy is through improved provider-patient communication"

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Health researchers see unique opportunity in self-tracker data | mobihealthnews

Health researchers see unique opportunity in self-tracker data | mobihealthnews | Patient Self Management | Scoop.it

As the number of self-tracking health and fitness tools available to consumers continues to climb, a persistent question has been whether the data they collect might be useful to health researchers. Along with that: Are people who self-track comfortable sharing their data with researchers?

A new, must-read report from San Diego’s California Institute for Telecommunications and Information Technology (Calit2), funded by the Robert Wood Johnson Foundation, explores these and other questions.

Based on a survey with hundreds of self-trackers, a majority — 57 percent — said one critical assurance they would need before agreeing to make their self-tracked, personal health data available to researchers was that their privacy would be protected. More than 90 percent also said it was important that their data remained anonymous. Respondents said they’d be more comfortable sharing data if they knew it was only going to be used for “public good” research. ..


One open-ended survey that the report’s researchers posed to self-trackers found that 13 percent of respondents specifically mentioned an aversion to commercial or profit-making use of their data, according to the report. One respondent wrote: “It depends who gets it. Research using these data will be instrumental in the future of personal predictive services, but also for that reason are likely to be exploited by marketers and the politically short-sighted. Thus I would like transparency for who has access to my data.”

Among the almost 100 health researchers interviewed for the report, 46 percent said that they had already used self-tracking data in their research previously. Some 23 percent reported that they had already worked with digital health companies that offer apps or devices to consumers to track their health. Overall, the researchers interviewed for the report were “generally enthusiastic” about the prospect of using self-tracking data in the future — 89 percent agreed or strongly agreed that such data would prove useful to their research efforts. Almost all of those researchers surveyed said that kind of data could answer questions that other data could not. ..


rob halkes's insight:

The research results stresses two things:

- The serious issue of privacy and data safety: clients indeed bear great value to what their own opinion tells them to want regarding the (non)use of their data: every idea as in "Well they wouldn't bother because they would not know" is a highly misguided starting point (See how the purchase of whatsapp by Facebook initiated a change of messaging app by lots of whatsapp users);

- As health persons are already active so much with their own health then they will get more insights into their own body than physicians would have based upon their general knowledge of medicine. Imagine what that would imply for the physician - patient interaction. The trend to disrupting health care will be reinforced.

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Patient Engagement Approaches: Paternalist vs. Patient-Centered | HealthWorks Collective

Patient Engagement Approaches: Paternalist vs. Patient-Centered | HealthWorks Collective | Patient Self Management | Scoop.it
The evidence is clear that a patient-centered approach -- not a paternalistic, “we know best” approach -- is linked to increased patient engagement, better outcomes, more adherent patients, lower utilization and better patient experiences.

..

The setting was a presentation last week at HIMSS 2014. The presenter was Chanin Wendling, the Director of eHealth at Geisinger Health System. Channing was talking about Geisinger’s often cited HIT-driven patient engagement efforts which includes their patient portal, health apps and recent foray into “Open Notes.”

What struck me was Chanin’s description of philosophical approach and communication style employed by Geisinger in the course of developing the content for theses engagement tools...

Here’s what she said.

“We tend to think in a paternalistic way: this is what the patient needs, versus thinking ‘What will work best for the patient?’ and ‘How will the patient relate to whatever we’re prescribing?’ And that’s extremely important because at the end of the day, if you can’t get the patient to help, if they don’t take their meds, if they don’t lose the weight, if they don’t do their exercises, there’s nothing you as a clinician can do. You need the patient to help you.”

Here are two things that jumped out at me from Chanin’s comments;

1. Geinsinger’s patient communication style is paternalistic and physician-directed…meaning it is the direct opposite of a patient-centered philosophical approach and communication style.

A patient-centered style begins with an understanding of the very things Chanin says Geisinger ignores – what will work best for the patient and how patients will relate to a proposed intervention.

The evidence is clear that a patient-centered approach -- not a paternalistic, “we know best” approach -- is linked to increased patient engagement, better outcomes, more adherent patients, lower utilization and better patient experiences.

2. Geisinger’s attitude that patients are inherently unengaged, e.g., won’t help clinicians unless told by clinicians what they need to do, is why so many heath care providers are having difficulty engaging patients at all levels of the organization, including patient portals. Think about it: 82% of U.S. adults visit their doctor at least once a year because “they” think it’s the right thing to do…and Geisinger thinks they are “not willing to help”? Are you kidding me?

The problem today is not that patients are unengaged…but that many providers aren’t very engaging. Sure 50% of patient re non-adherent…but 20% of patient non-adherence has been attributed to poor communications on the physician’s part, e.g., paternalistic, physician-directed communications. Sure less than 10% of patients visit the average patient portal in a year…but when portal contents and functionality treat one like an uncooperative child why would one expect a higher level of adoption?


Via Chanfimao, Lionel Reichardt / le Pharmageek
rob halkes's insight:

Changing care for health isn't easy. Of course doctors will wrestle with on the one hand their "normative" medical evidence-based guidelines, and at the other a patient's understanding and need for guidance in their coping with both conditions and willingness to adhere to advice. A profession that knows how to bridge this dilemma is the teaching profession. Imagine.. Why not teach physicians as well.. ;-)

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FDA clears two wristworn fitness trackers for clinical trials | mobihealthnews

FDA clears two wristworn fitness trackers for clinical trials | mobihealthnews | Patient Self Management | Scoop.it

A British company, Camntech, has received FDA clearancefor a motion-tracking wristband and a wristworn electronic diary, likely for use in clinical trials.

The devices are called the MotionWatch 8 and PRO-Diary. According to the filing, the devices ”are intended for the acquisition and analysis of the physical activity of the body during daily living and sleep.” The devices upload data to a PC via a USB cord.

rob halkes's insight:

wearables, wearables... Indeed the future. But still, when it is not integrated with viewing, inspecting supporting information, will it be of practical, steady use.
There will be a phenomenon like half-time value to consumers' use. How to prolongue that needs to be a serious concern to the industry of wearables.

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Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes

Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes | Patient Self Management | Scoop.it
Patient Education and Counseling, Volume 94, Issue 2, Pages 187-192, February 2014, Authors:Eva Boström; Ulf Isaksson; Berit Lundman; Ulla H. Graneheim; Åsa Hörnsten
Objective

The aim of this study was to explore the interaction between diabetes specialist nurses (DSNs) and patients with type 2 diabetes (T2D) during group sessions about self-management.

Methods

Ten DSNs and 44 patients were observed during group sessions about self-management, and thereafter the observations were analyzed using qualitative content analysis.

Results

The interaction was characterized by three themes: becoming empowered, approaching each other from different perspectives, and struggling for authority. The interaction was not a linear process, but rather a dynamic process with distinct episodes that characterized the content of the sessions.

Conclusion

It is important to achieve an interaction that is patient-centered, where the DSN is aware of each patient's individual needs and avoids responding to patients in a normative way. A satisfying interaction may strengthen patients’ self-management, and also may strengthen the DSNs in their professional performance.

Practice implications

Authority struggles between patients and DSNs could be a prerequisite for patients to become autonomous and decisive in self-management. DSNs might benefit from an increased awareness about this issue, because they can better support patients if they do not perceive authority struggles as threats to their professional role.

rob halkes's insight:

It's all in the conclusion, to quote: "t is important to achieve an interaction that is patient-centered, where the DSN is aware of each patient's individual needs and avoids responding to patients in a normative way. A satisfying interaction may strengthen patients’ self-management, and also may strengthen the DSNs in their professional performance."

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Health records of every NHS patient to be shared in vast database - Telegraph

Health records of every NHS patient to be shared in vast database - Telegraph | Patient Self Management | Scoop.it

The health records of everyone in the NHS will be pooled in a vast database which can be accessed by researchers and pharmaceutical companies. But campaigners warn it could breach privacy.But campaigners warn it could breach privacy.

By Sarah Knapton, Science Correspondent

he medical notes of every NHS patient are to be pooled in a vast database to improve research.

In the coming days every household in Britain will receive a letter advising them that, from April, their medical histories will be shared with researchers and pharmaceutical companies unless they opt out.

Today leading charities including Cancer Research UK, Diabetes UK and the British Heart Foundation launch a campaign to highlight the importance of allowing the notes to be accessed for the advancement of medical science.

They say the database will help them understand the causes of disease, spot side-effects to new drugs and detect outbreaks of infectious diseases.

Doctors have promised that patients will remain anonymous. But data protection campaigners have warned that individuals risk being identified and that the notes may be inaccurate.

Health professionals have admitted the ‘care.data’ database could be vulnerable to targets from hackers and criminal networks, but say it is necessary to improve the health service.....

[ Read the full blog! Specifically quotes from experts for and against this registration }

 

rob halkes's insight:

My first response was "Wow", here's a national health institute that moves forward. But then, in relfection: "OMG" is this what we want? Ok, patients may opt out, but is this the way to moveforward in health care personal records, in gathering data etc.?

I guess more nuanced approaches are at hand.

A suggestion: if you don't knwo what ot htink of it: just make an analysis: what cateogry of involved people gain what benefits, versus the analysis who's interests are endangered and how.. it will give you an insight and a clue to your opinion ;-)

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Nurse helps patients take control of their health - KansasCity.com

Nurse helps patients take control of their health - KansasCity.com | Patient Self Management | Scoop.it

When John "Chuck" Lenferink was being readied to fly from Campbell County Memorial Hospital to Denver in August, he turned to Angela Roesler and said, "This is going to kill me, isn't it?

The nurse looked at her 68-year-old chronically ill patient and told him "yes." If he didn't make some big changes, and soon, his chronic obstructive pulmonary disease (COPD) and congestive heart failure would be the death of him.

At the time, Lenferink was averaging one hospital stay and at least two emergency room visits per month. If he wasn't in the hospital for heart failure, it was for COPD. He was overweight, he couldn't breathe without oxygen and things were only getting worse.

Lenferink is stubborn. He'll be the first to say he doesn't like being told what to do. But faced with his own mortality, he knew he needed to listen to his favorite nurse.

"When he came home, he was a changed man," Roesler said.

Roesler loves being a nurse, and she also loves to teach. When the hospital decided to create a transition care program in May, she was ecstatic.

"It's the best of both worlds," she said.

Roesler had been an acute care nurse in the medical surgical department since 2009, but the change to a transition care nurse was easy.

"It's about the people," she said. "I love my patients, and I love this job."

...

participating patients must be 65 or older and have one of the 10 most common diagnoses for readmitted patients, which are: congestive heart failure, COPD, coronary artery disease, diabetes mellitus, stroke, hip fracture, peripheral vascular disease, pulmonary embolism, chronic back pain and cardiac arrhythmia.

The nurses meet with at-risk patients while they're still in the hospital and then do a home visit once they are discharged.

"We don't do any acute assessments. We don't take blood pressures. We don't do what public health and home health agencies do," Roesler said. "We don't compete with them. We're kind of an adjunct to them."

The nurses act as a liaison between the patient, their doctors and the hospital. Their main goal is education and empowerment.

During the first home visit, the transition care nurses go over the discharge information that the hospital gave the patient and come up with an action plan.

The biggest challenge during the first visit is medication reconciliation, Roesler said. The nurse and patient go through all the patient's medications together and outline which pills the patient should be taking, how often and why.

... "This is a great program. I'm very thankful the hospital decided to do it," Roesler said. "It's definitely made a difference in the lives of real people." ...

It's not a time-driven program, so you get time with your patients, and you get to invest in them and in their success," she said.

Patients are taking control of their health, and the hospital is seeing its readmission rates go down for patients 65 and older.

"I think it's a good fit for every community, honestly," Roesler said. "It probably works well here because we are a community-focused hospital. We're it. So when people go to the hospital, they're going to come here, and when they go home they're going to look back to us to help them succeed at home."

...

The hospital doesn't charge patients to use the service, and it's not getting reimbursed for it. The hope is that the program will work so well that the hospital will continue to provide the service once the grant stops paying the nurses' salaries.

"It's the right thing to do for the patients, and that's what I love," Roesler said. "If it's the right thing to do, then let's keep doing it."


Read more here: http://www.kansascity.com/2014/01/09/4739811/nurse-helps-patients-take-control.html#storylink=cpy

rob halkes's insight:

Great intitiative to support the patient in coping with his condition and with his therapy. Lots of difficult issues for patients arise in trying to adhere to the therapy that are not to their understanding. An area of support crucial to implementation of the care program. An area that is readily understood to be as a focus area in telecare/ehealth. As one states: "Once a plan is established, transition care nurses continue to make contact with their patients either by phone or in person at least once a week to check in. Often times, the biggest hump for patients to overcome is to be able to identify negative symptoms and call the doctor." Such function as "transition nurse" would be all and continuous at hand through a weel designed ehealth plan. Don't you think?

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rob halkes's curator insight, January 13, 11:22 AM

Great intitiative to support the patient in coping with his condition and with his therapy. Lots of difficult issues for patients arise in trying to adhere to the therapy that are not to their understanding. An area of support crucial to implementation of the care program. An area that is readily understood to be as a focus area in telecare/ehealth. As one states: "Once a plan is established, transition care nurses continue to make contact with their patients either by phone or in person at least once a week to check in. Often times, the biggest hump for patients to overcome is to be able to identify negative symptoms and call the doctor." Such function as "transition nurse" would be all and continuous at hand through a weel designed ehealth plan. Don't you think?

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Proactive integrated care improves quality of life in patients with COPD

Proactive integrated care improves quality of life in patients with COPD | Patient Self Management | Scoop.it
Research from European respiraotiry journal 2009, by Koff, P.B. a.o. Abstract

Self-management strategies improve a variety of health-related outcomes for patients with chronic obstructive pulmonary disease (COPD). These strategies, however, are primarily designed to improve chronic disease management and have not focused on early detection and early treatment of exacerbations. In COPD, the majority of exacerbations go unreported and treatment is frequently delayed, resulting in worsened outcomes. Therefore, a randomised clinical trial was designed to determine whether integration of self-management education with proactive remote disease monitoring would improve health-related outcomes.

A total of 40 Global Initiative for Chronic Obstructive Lung Disease stage 3 or 4 COPD patients were randomised to receive proactive integrated care (PIC) or usual care (UC) over a 3-month period. The primary and secondary outcomes were change in quality of life, measured by the St George’s Respiratory Questionnaire (SGRQ), and change in healthcare costs.

PIC dramatically improved SGRQ by 10.3 units, compared to 0.6 units in the UC group. Healthcare costs declined in the PIC group by US$1,401, compared with an increase of US$1,709 in the UC group, but this was not statistically significant. PIC uncovered nine exacerbations, seven of which were unreported.

Therefore, proactive integrated care has the potential to improve outcomes in chronic obstructive pulmonary disease patients through effects of self-management, as well as early detection and treatment of exacerbations.

rob halkes's insight:

Already in 2009, this research shows how technology by itself will not improve QoL or outcomes of health, but implementation with some characteristics of integrated care does.

Ehealth is not simple but promising!

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The Myth Of Patient-Centered Care

The Myth Of Patient-Centered Care | Patient Self Management | Scoop.it

I can’t think of any strategic initiative in recent time with more potential to engage and active patients, improve patient health outcomes and enhance patient experiences than the call by the Institute of Medicine in Crossing the Quality Chasmfor providers to become more patient-centered.  Specifically, more patient-centered in the way they communicate with patients.

Having spent years working in the field, I am continually amazed at the rich body of evidence documenting the wide range of strategic benefits of engaging patients in conversations about their health goals, beliefs, motivations and expectations.   I am also amazed at how slow health plans, hospitals systems and the like have been to leverage the benefits of patient-centered communications within their provider networks.

A 2011 article in BMJ’s journal Quality and Safety highlight the present state of affairs with respect to patient-centered communications in the U.S.

The study looked at how often physicians employed the most essential and defining patient-centered communication skill – asking patients about what they expected from their health encounter.   In the case of the study, asking patients what they expected from a required hospital stay…although the finding could just as easily come from a study of physician office visits.
Why Is Understanding The Patient’s Expectations Important?
The basic premise of patient-centered care is that, where practicable, the clinician should honor the patient’s beliefs, motivations fears and expectations in the course of treating them. Obviously before you can “honor” the patient’s “perspective” you first need to understand what they are. The clinician needs to ask the patient.

And there’s the rub.

 

Turns out that only 16% of physicians in the study (residents and attending physicians) admitted to routinely asking their patients about their health care-related expectations. ...


Read on!


rob halkes's insight:

As long as patietns are not asked about their condition, care never be all right enough. "Turns out that only 16% of physicians in the study (residents and attending physicians) admitted to routinely asking their patients about their health care-related expectations"..

 

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Digital tools and online health services poised to play key role in consumer health management, study finds - Manhattan Research

Digital tools and online health services poised to play key role in consumer health management, study finds - Manhattan Research | Patient Self Management | Scoop.it
Health engagement online deepening at a time when consumers are expected to take a greater role in their care

 

October 10, 2013, New York, NY – Consumers have long used health websites and other online tools to gather information about conditions and treatments. Now they are broadening their health activity online, using Internet resources to support healthcare decision-making and to manage conditions, a new study shows.

Forty-five percent of online U.S. adults with a chronic condition say that the Internet is essential to managing their disease or condition, according to the Cybercitizen Health® U.S. 2013 study from healthcare market research and advisory firm Manhattan Research.

“We’ve hit an inflection point in the way consumers use the internet for health,” said Rory Stanton, Consumer Insights Analyst at Manhattan Research. “They are going beyond seeking-information to using tools and services to manage the day-to-day aspects of care. That’s good news in this post–healthcare reform environment, in which digital engagement of consumers for example via patient portals and telehealth will be a key to success.”

The study also found that online content and services influence how consumers approach health management for themselves and their dependents, with 44 percent of online consumers agreeing that the Internet is essential for their health and medical decision-making.

These and other study findings highlight key opportunities for various health stakeholders, such as pharmaceutical companies, provider networks, and payers, to provide technology-based value added services and empower deeper engagement from end users.

 

rob halkes's insight:

"An inflection point": a turn actually, in patients' use of the internet: from seeking information to using tools  and services to manage the day-to-day aspects of care.

Actually, health care really turns into "care for health"!  It will impact health care systems when patients pick up their own responsibility for thier proper care for health. Let's see how this evolves!

Actually too, ehealth will connect patients with medical professional which will support them!

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