Continuity of care experienced by patients in a multi-institutional pancreatic care network: a pilot study

Hopstaken, Jana S.; Dalen, Demi van; Kolk, B.M. van der; Geenen, Erwin J M van; Hermans, John J.; Gootjes, Elske C.; Schers, Henk; Dulmen, A.M. van; Laarhoven, Cees J. H. M. van; Stommel, Martijn W J

doi:10.1186/s12913-021-06431-2

Cited by 8 publications

(7 citation statements)

References 32 publications

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“…Our study indicated that the COC was not sufficiently achieved by most people with diabetes and hypertension, as documented in the existing literature. Using NCQ to measure COC across care levels, similar to our results, a study in the Netherlands found a mean COC value for their population of 3.38 (SD = 0.72) [ 41 ]. The COCI results in our study were consistent with a previous study in Korea (2013) (COCI for four-year follow-up in T2DM: 0.75) [ 42 ], lower than another study in Korea (2019) (COCI among diabetic people: 0.83) [ 21 ], and higher than a study in Italy (2016) (COCI for multiple chronic conditions: 0.44) [ 43 ], in China (2017–2019) (COCI for hypertension and T2DM: 0.58) [ 20 ] and in Norway (2021) (COCI for T2DM: 0.67 and COCI for heart failure: 0.77) [ 44 ].…”

Section: Discussionsupporting

confidence: 84%

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Continuity of primary care for type 2 diabetes and hypertension and its association with health outcomes and disease control: insights from Central Vietnam

Le Ho Thi,

Pype,

Wens

et al. 2024

BMC Public Health

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Background Vietnam is undergoing a rapid epidemiological transition with a considerable burden of non-communicable diseases (NCDs), especially hypertension and diabetes (T2DM). Continuity of care (COC) is widely acknowledged as a benchmark for an efficient health system. This study aimed to determine the COC level for hypertension and T2DM within and across care levels and to investigate its associations with health outcomes and disease control. Methods A cross-sectional study was conducted on 602 people with T2DM and/or hypertension managed in primary care settings. We utilized both the Nijmegen continuity of care questionnaire (NCQ) and the Bice - Boxerman continuity of care index (COCI) to comprehensively measure three domains of COC: interpersonal, informational, and management continuity. ANOVA, paired-sample t-test, and bivariate and multivariable logistic regression analysis were performed to examine the predictors of COC. Results Mean values of COC indices were: NCQ: 3.59 and COCI: 0.77. The proportion of people with low NCQ levels was 68.8%, and that with low COCI levels was 47.3%. Primary care offered higher informational continuity than specialists (p < 0.01); management continuity was higher within the primary care team than between primary and specialist care (p < 0.001). Gender, living areas, hospital admission and emergency department encounters, frequency of health visits, disease duration, blood pressure and blood glucose levels, and disease control were demonstrated to be statistically associated with higher levels of COC. Conclusions Continuity of primary care is not sufficiently achieved for hypertension and diabetes mellitus in Vietnam. Strengthening robust primary care services, improving the collaboration between healthcare providers through multidisciplinary team-based care and integrated care approach, and promoting patient education programs and shared decision-making interventions are priorities to improve COC for chronic care.

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Section: Discussionsupporting

confidence: 84%

“…Each subscale eventually has a mean score. NCQ scores below four are interpreted as low and mean scores of four or higher as high continuity of care [ 41 ].…”

Section: Methodsmentioning

confidence: 99%

Continuity of primary care for type 2 diabetes and hypertension and its association with health outcomes and disease control: insights from Central Vietnam

Le Ho Thi,

Pype,

Wens

et al. 2024

BMC Public Health

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“…However, there were no significant findings for the primary outcome with recoding, sensitivity analysis, or secondary analysis examining the NCQ TCC change scores between baseline and FUP1. Similar to this study, Hopstaken et al [38] reported that 36% to 41% of patients did not know how to respond to the TCC subscale items in their study involving patients with pancreatic cancer. We learned that most patients were unaware of the communication between their health care providers regarding their care and may have assumed that it was adequate unless specific problems arose (data not shown).…”

Section: Principal Findingssupporting

confidence: 77%

“…Previous research has suggested that the NCQ is a reliable and valid measure, with no ceiling effects observed for the TCC subscale in a study involving patients with pancreatic cancer [ 38 ]. The NCQ TCC results may have been affected by too much noise (sources of variation) owing to the high volume of health care activities patients are involved in (particularly during the treatment phase), and it may have been difficult for the intervention to have an effect.…”

Section: Discussionmentioning

confidence: 99%

Web-Based Asynchronous Tool to Facilitate Communication Between Primary Care Providers and Cancer Specialists: Pragmatic Randomized Controlled Trial

Petrović¹,

Julian²,

Liddy³

et al. 2023

J Med Internet Res

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Background Cancer poses a significant global health burden. With advances in screening and treatment, there are now a growing number of cancer survivors with complex needs, requiring the involvement of multiple health care providers. Previous studies have identified problems related to communication and care coordination between primary care providers (PCPs) and cancer specialists. Objective This study aimed to examine whether a web- and text-based asynchronous system (eOncoNote) could facilitate communication between PCPs and cancer specialists (oncologists and oncology nurses) to improve patient-reported continuity of care among patients receiving treatment or posttreatment survivorship care. Methods In this pragmatic randomized controlled trial, a total of 173 patients were randomly assigned to either the intervention group (eOncoNote plus usual methods of communication between PCPs and cancer specialists) or a control group (usual communication only), including 104 (60.1%) patients in the survivorship phase (breast and colorectal cancer) and 69 (39.9%) patients in the treatment phase (breast and prostate cancer). The primary outcome was patient-reported team and cross-boundary continuity (Nijmegen Continuity Questionnaire). Secondary outcome measures included the Generalized Anxiety Disorder Screener (GAD-7), Patient Health Questionnaire on Major Depression, and Picker Patient Experience Questionnaire. Patients completed the questionnaires at baseline and at 2 points following randomization. Patients in the treatment phase completed follow-up questionnaires at 1 month and at either 4 months (patients with prostate cancer) or 6 months following randomization (patients with breast cancer). Patients in the survivorship phase completed follow-up questionnaires at 6 months and at 12 months following randomization. Results The results did not show an intervention effect on the primary outcome of team and cross-boundary continuity of care or on the secondary outcomes of depression and patient experience with their health care. However, there was an intervention effect on anxiety. In the treatment phase, there was a statistically significant difference in the change score from baseline to the 1-month follow-up for GAD-7 (mean difference −2.3; P=.03). In the survivorship phase, there was a statistically significant difference in the change score for GAD-7 between baseline and the 6-month follow-up (mean difference −1.7; P=.03) and between baseline and the 12-month follow-up (mean difference −2.4; P=.004). Conclusions PCPs’ and cancer specialists’ access to eOncoNote is not significantly associated with patient-reported continuity of care. However, PCPs’ and cancer specialists’ access to the eOncoNote intervention may be a factor in reducing patient anxiety. Trial Registration ClinicalTrials.gov NCT03333785; https://clinicaltrials.gov/ct2/show/NCT03333785

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“…Research has demonstrated an important opportunity to improve both care coordination and clinical management of patients throughout their multi-modal treatment processes 8,9 .…”

Section: Introductionmentioning

confidence: 99%

Closing the Patient-Provider Gap Along the Surgical Journey One Click at a Time: Results of a Phase I Pilot Trial of a Patient Navigation Tool

Shoucair

Downing

O’Rourke

et al. 2023

Preprint

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Background Patients diagnosed with complex hepato-pancreaticobiliary (HPB) conditions experience a complex journey through the health care system. Patient navigation is commonly offered to patients and their caregivers throughout this complex journey. We developed and tested a prototype web-based dual (patient and provider) navigation application ‘PatientNav’. We report on phase I of the study, which evaluated the app in multiple domains: usability, functionality, and reliability. Methods Evidence-based recommendations determined throughout a needs assessment. PatientNav app was designed to be a highly customizable tool based both on needs of the patient, care team and characteristics of the institution. Our phase I pilot trial targeted individuals aged 18 years or older who reported the capacity to use a mobile app or desktop website presenting to our HPB transplant clinic at MedStar Georgetown University Hospital/Lombardi Comprehensive Cancer Center over a 2-month period. Usability, functionality, and reliability testing was conducted by applying multiple strategies that include biometric data analysis, task completion, questionnaires, and interviews. Results The usability rate of PatientNav among patient app users was 95.4%. Out of 22 patients, 18 (81.8%) completed the in-app survey whose responses were included in the analysis. Among patient app users who completed the in-app survey questionnaire, 66.6% reported that content in PatientNav app was relevant. In terms of reliability of the app, none of the patient app users reported issues with technical issues with accessing PatientNav throughout the study period. To further elucidate the characteristics of individuals who exhibited high usage of the PatientNav assigned task functions, we divided our cohort based on median number of tasks used (N = 75 total tasks). Univariable comparison showed that high function users were older with a median (IQR) of 61.5 (57.8, 71.3) compared to 52.2 (34.5, 65.7) years among low function users. No differences were observed based on gender, racial distribution, living condition or occupation. However, 41.7% of low function users had Medicare/Medicaid insurance whereas all high function users had private or combined insurance. Conclusion Our phase I pilot study showed that PatientNav is a feasible, usable and functional technological tool that enables patients with complex HPB diagnoses and their care team to interface in real time using PROMs. PatientNav is a reliable tool that can be used by clinical and support staff to help navigate patients through surgery and aftercare, and by patients to assist in navigation and self-management. Trial Registration: The trial was registered at ClinicalTrials.gov; Registration number: NCT04892927; date of registration: 5/19/2021.

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Continuity of care experienced by patients in a multi-institutional pancreatic care network: a pilot study

Cited by 8 publications

References 32 publications

Continuity of primary care for type 2 diabetes and hypertension and its association with health outcomes and disease control: insights from Central Vietnam

Continuity of primary care for type 2 diabetes and hypertension and its association with health outcomes and disease control: insights from Central Vietnam

Web-Based Asynchronous Tool to Facilitate Communication Between Primary Care Providers and Cancer Specialists: Pragmatic Randomized Controlled Trial

Closing the Patient-Provider Gap Along the Surgical Journey One Click at a Time: Results of a Phase I Pilot Trial of a Patient Navigation Tool

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