Patients, clinicians and researchers working together to improve cardiovascular health: a qualitative study of barriers and priorities for patient-oriented research

Santana, Maria-Jose; Zelinsky, Sandra; Ahmed, Sadia; Doktorchik, Chelsea; James, Matthew T.; Wilton, Stephen B.; Quan, Hude; Fernández, Nicolás; Anderson, Todd J.; Butalia, Sonia

doi:10.1136/bmjopen-2019-031187

Cited by 13 publications

(10 citation statements)

References 27 publications

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“…Patients bring their own experience, expectations and expertise to their care [ 1 , 2 ]. The provision of personalized care is one of the main goals of healthcare systems [ 3 ], and patient-reported outcomes can facilitate that.…”

Section: Introductionmentioning

confidence: 99%

Patient-led use of patient-reported outcome measure in self-Management of a Rotator Cuff Injury

Santana

Tomkins

2021

J Patient Rep Outcomes

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Introduction The patient is the person who experiences both the processes and the outcomes of care. Information held by the patient is vital for clinical and self-management, improving health outcomes, delivery of care, organization of health systems, and formulation of health policies. Patient-reported outcome measures (PROMs) play an important role in supporting patient’s self-management. This narrative describes a patient-led use of a PROM to self-manage after a rotator cuff injury. Methods This is a narrative of a patient who tore the supraspinatus tendon in her right shoulder in an accident. The Disabilities of the Arm, Shoulder and Hand, the DASH questionnaire, was used to monitor and self-manage recovery after the accident. The DASH questionnaire is a self-reported questionnaire that measures the difficulty in performing upper extremity activities and pain in the arm, shoulder or hand. It has been widely used in research studies, but here the patient initiated its use for self-management while waiting for and after rotator cuff surgery. The patient created separate sub-scale scores for function and for pain to answer questions from healthcare providers about her recovery. Results There was noticeable improvement over 3 months of conservative treatment, from a high level of disability of 56 to 39 (score changed 17); however, the scores were nowhere near the general population normative score of 10.1. Surgery improved the score from 39 pre-surgery to 28. Post-surgical interventions included physiotherapy, pain management and platelet-riched plasma treatment (PRP). The score was 14 4 weeks post-PRP. Conclusions The patient found the DASH useful in monitoring recovery from a rotator cuff injury (before and after surgery). The DASH contributed to communication with healthcare professionals and supported the clinical management. The DASH questionnaire was able to capture the patient’s experience with the injury and surgical recovery, corroborating an improvement in function while there was persistent post-surgical pain.

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Section: Introductionmentioning

confidence: 99%

Patient-led use of patient-reported outcome measure in self-Management of a Rotator Cuff Injury

Santana

Tomkins

2021

J Patient Rep Outcomes

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“…The design of the Contrast RISK initiative was informed by initial input from 6 patient advisors from the Alberta Health Services’ Cardiovascular Health and Stroke Strategic Clinical Network and the Kidney Health Strategic Clinical Network. 13 , 14 On the basis of past experiences, these advisors provided recommendations for the initiative to improve patient experience through standardized communication of risk information, clarifying instructions on the follow-up steps for patients after the procedure, and enhancing communication to their primary care provider. Patient advisors reviewed and approved the final protocol for the initiative and the plan for evaluation of patient experience.…”

Section: Methodsmentioning

confidence: 99%

Patient Experience After Risk Stratification and Follow-up for Acute Kidney Injury After Cardiac Catheterization: Patient Survey

et al. 2021

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Background Acute kidney injury (AKI) after cardiac catheterization procedures is associated with poor health outcomes. We sought to characterize the experiences of patients after receiving standardized information on their risk of AKI accompanied by instructions for follow-up care after cardiac catheterization. Methods We implemented an initiative across 3 cardiac catheterization units in Alberta, Canada to provide standardized assessment, followed by guidance for patients at risk of AKI. This was accompanied by communication to primary care providers to improve continuity of care when patients transition from the hospital to the community. A structured survey from a sample of 100 participants at increased risk of AKI determined their perceptions of information provided and experiences with follow-up steps after the initiative was implemented in each cardiac catheterization unit in Alberta. Results The mean age of participants was 72.4 (SD 10.4) years, 37% were female, and the mean risk of AKI was 8.8%. Most (63%) participants were able to recall the information provided to them about their risk of kidney injury, 68% recalled the education provided on strategies to reduce risk, and 65% believed their primary care practitioner had received enough information to conduct appropriate follow-up care. Eighty-six percent of patients were satisfied with their transition to the community, and 53% were reassured by the information and follow-up care they received. Conclusions These findings suggest that communicating risk information to patients, in combination with education and collaboration for follow-up with primary care providers, is associated with positive patient experiences and satisfaction with care.

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“…Patients were recruited through posters in various clinical spaces as well as inviting patients who are part of an established cardiovascular health advisory panel who had agreed to be contacted about research opportunities for study participation. 31 Patients who met the following criteria were eligible: (1) age ≥ 18 years and (2) potential recipients of statins (ie, those with statin-indicated conditions such as history of CVD, diabetes, and/or chronic kidney disease).…”

Section: Methodsmentioning

confidence: 99%

Barriers and Facilitators to Using Statins: A Qualitative Study With Patients and Family Physicians

et al. 2020

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Background Despite their proven efficacy to reduce cardiovascular disease, statin medication use remains low in individuals at high risk of cardiovascular disease considering their widespread availability and safety. Our objective was to explore the perspectives of patients and family physicians with regard to the barriers and facilitators of statin use in primary care. Methods In this qualitative descriptive study, we conducted 2 focus groups with patients (number, n = 8/6) and individual semistructured interviews with family physicians (n = 17) from community settings. Interviewers asked participants about barriers to and facilitators of statin use. Focus groups and interviews were digitally recorded, transcribed, and analyzed in duplicate using conventional content analysis. Results Patients were averse to taking statins for a variety of reasons: medication avoidance and burden; inadequate buy-in for statin therapy; and difficulty remembering to take statins regularly. Family physicians perceived similar barriers and reported other barriers: lack of resources such as inadequate tracking systems; specialist-primary care provider guideline discordance; and lack of continuity and relationship. Patients expressed that key facilitators were patient education and support; splitting tablets to increase cost-effectiveness; and changing to a different statin or lower dose in those with side effects. Family physicians described several similar strategies to facilitate therapy as well as shared decision making and clinical decision support tools as enablers for improvement. Conclusions We identified several important barriers to and facilitators of statin use at the patient and prescriber level. This information offers insight into strategies to improve statin use and the development of innovative programs and interventions.

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Patients, clinicians and researchers working together to improve cardiovascular health: a qualitative study of barriers and priorities for patient-oriented research

Cited by 13 publications

References 27 publications

Patient-led use of patient-reported outcome measure in self-Management of a Rotator Cuff Injury

Patient-led use of patient-reported outcome measure in self-Management of a Rotator Cuff Injury

Patient Experience After Risk Stratification and Follow-up for Acute Kidney Injury After Cardiac Catheterization: Patient Survey

Barriers and Facilitators to Using Statins: A Qualitative Study With Patients and Family Physicians

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