A call to excellence in patient experience

In this address, the incoming associate editor describes his early experience with the Patient Experience Journal (PXJ) and issues a call to action to the PXJ community. In the call to action, the PXJ community is asked to build upon our collective history of scholastic and practical excellence. The combination of practical relevance and methodological rigor in our contributions will help to ensure a future in which patient experience is paramount in health service delivery conversations. In addition, gaps in the patient experience literature and emergent opportunities for theoretical and practical contributions are recommended

“\u3cb\u3ePICO\u3c/b\u3e”: \u3cb\u3eP\u3c/b\u3eractice EBM skills, \u3cb\u3eI\u3c/b\u3encrease student interests with \u3cb\u3eC\u3c/b\u3eollaboration of librarians and improve \u3cb\u3eO\u3c/b\u3eutcomes

Available literature on teaching evidence-based medicine (EBM) to medical students focuses on teaching critical appraisal skills, often in the context of a journal club, workshops or lectures. Being able to utilize EBM effectively means that a learner is able to take a clinical scenario, develop a clinically relevant question, search for the evidence, appraise that evidence, and apply the results of this appraisal back to the individual patient. Hence EBM activity is more likely to become a part of clinical decision-making if medical students practice the skills in the context of direct patient care

An Initiative to Educate and Support Young Adults Diagnosed with Hypertension

An Initiative to Educate and Support Young Adults Diagnosed with Hypertension Page Tomlinson, BS, RN, DNPc Background: Hypertension is a common diagnosis in the US with significant long-term effects. While guidelines for optimal hypertension management exist, young adults lag behind older adults in treatment and control3. The young adult is arguably more capable of lifestyle changes, primarily due to fewer physical limitations than older adults. Promotion of disease self-management is the most effective way to engage young adults in seeking control over their blood pressure1,2. Lifestyle modification as a young adult decreases costs of care and risk for cardiovascular events, while lack of guidance and support at this stage of life may increase risk for cardiac events over their lifetime. This project examined disease self-management in young adults aged 18-39 years at a local primary care office. Methods. Patients aged 18-39 years with diagnosis of hypertension were identified. A questionnaire on self-efficacy in hypertension management was sent and preference for lifestyle modification counseling (LMC) was assessed. Follow up calls placed. Semi-structured interviews conducted. Provider survey conducted. Results: Three patients discussed their experience of being diagnosed with hypertension in semi-structured interviews. Fourteen patients were not interested in participating. Provider survey (n=7) response 100%. Patient information handout created. Conclusions. While the literature demonstrates the positive effect of LMC on outcomes in hypertensive young adults, efforts to engage this population proved challenging. Young adults desire consistent guidance and support with lifestyle modification yet are unwilling to engage in lifestyle modification when they are asymptomatic and do not have rapport with the offering provider. Key Words: hypertension, young adult, support, lifestyle modification Word count [246] References: Johnson, H., Olson, A., Lamantia, J., Kind, A., Pandhi, N., Mendonça, E., Craven, M., & Smith, M. (2015). Documented lifestyle education among young adults with incident hypertension. Journal of General Internal Medicine, 30(5), 556-64. Trento, M., & Porta, M. (2012). Structured and Persistently Reinforced Patient Education Can Work. BMJ: British Medical Journal 345, e5100. Zhang, Y. E., & Moran, A. (2017). Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension Among Young Adults in the United States, 1999 to 2014. Hypertension, 70(4), 736-742

General practice palliative care: Patient and carer expectations, advance care plans and place of death-a systematic review

Background: With an increasing ageing population in most countries, the role of general practitioners (GPs) and general practice nurses (GPNs) in providing optimal end of life (EoL) care is increasingly important. Objective: To explore: (1) patient and carer expectations of the role of GPs and GPNs at EoL; (2) GPs’ and GPNs’ contribution to advance care planning (ACP) and (3) if primary care involvement allows people to die in the place of preference. Method: Systematic literature review. Data sources: Papers from 2000 to 2017 were sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases. Results: From 6209 journal articles, 51 papers were relevant. Patients and carers expect their GPs to be competent in all aspects of palliative care. They valued easy access to their GP, a multidisciplinary approach to care and well-coordinated and informed care. They also wanted their care team to communicate openly, honestly and empathically, particularly as the patient deteriorated. ACP and the involvement of GPs were important factors which contributed to patients being cared for and dying in their preferred place. There was no reference to GPNs in any paper identified. Conclusions: Patients and carers prefer a holistic approach to care. This review shows that GPs have an important role in ACP and that their involvement facilitates dying in the place of preference. Proactive identification of people approaching EoL is likely to improve all aspects of care, including planning and communicating about EoL. More work outlining the role of GPNs in end of life care is required