Patient-based mobile alerting systems- requirements and expectations

Patients with chronic conditions are not well supported by technical systems in managing their conditions. However, such systems could help patients to self-reliantly comply with their treatment. This help could be rendered in the form of alerting patients about condition-relevant issues, transmitting relevant parameters to healthcare providers and analysing these parameters according to guidelines specified by both patients and healthcare staff. If necessary, this analysis of condition parameters triggers the alerting of patients and healthcare providers about actions to be taken. In this paper, we present the results of a survey we have undertaken to verify and extend requirements we have identified for the design of a Mobile Alerting System for patients with chronic conditions. First of all, the results show that a Mobile Alerting System is desired by patients. Moreover, due to the inter- and intra-user variance of patients and healthcare staff, the system has to work in a context-aware manner and allow for personalised parameters in order to be adaptable to every user’s needs

Postpartum Patients Reports of Satisfaction with a Welcome Meal after a Vaginal Delivery

Objective: The purpose of this research study was to assess patient perspectives regarding a special Welcome Meal. The focus was on patients\u27 feeling welcomed and important because prior research has shown that when a patient\u27s expectations are exceeded, patient satisfaction increases. This study suggests that receiving a Welcome Meal may improve their experience on a postpartum unit. Design: Prior to discharge, each patient on the maternity unit was served a special Welcome Meal. A questionnaire was given to patients that consisted of six questions. The six questions incorporated six themes found in research literature on improving patient satisfaction. These themes included exceeding one\u27s expectations, feeling important, feeling welcome, having a positive experience, increasing one\u27s morale and providing good quality food. Patients/Participants: The sample consist~d of 30 postpartum patients between the ages of 20-47 whom had undergone a vaginal delivery of a live infant. Results: The highest rated question indicated that the Welcome Meal made the patients feel welcome (96.6%). The second highest rated question shows the Welcome Meal to be of good quality (96.6%). The Welcome Meal not only made the patient feel important, but also created a more pleasant hospital experience. Overall 86.6% agreed that it gave a positive experience and exceeded their expectations (90%). Conc1usion: The research indicated that the six themes found in improving patient satisfaction were also present when asked about the Welcome Meal. The limitations to the study include having a small non-random sample of 30 patients. This study suggests that having such a meal implemented on the maternity unit may have a positive impact on patient satisfaction. Future studies should provide a larger sample size. Further research is needed to correlate improved patient satisfaction and the Welcome Meal in a pre and post test design

Patient expectations: Is there a typical patient?

Objectives: To qualitatively explore, and analyse, patients’ expectations before the start of fixed appliance orthodontic treatment and determine whether typologies exist. Design: A prospective cross-sectional qualitative study, which involved 13 patients (aged 12–15 years). Setting: NHS Hospital Orthodontic Department (UK). Materials and methods: In-depth interviews were conducted with patients who consented to participate before the start of fixed appliance orthodontic treatment. The in-depth interview data were transcribed and then managed using a framework approach, followed by associative analysis. Results: The in-depth interviews revealed two major themes and associated subthemes which were: first, patients’ expectations about the treatment process and outcome; and second, patients’ expectations of themselves during and after treatment. Three typologies related to patients’ expectations of the orthodontic treatment process were also identified. The first group of participants had minimal expectations of the treatment process, did not anticipate discomfort or pain and did not anticipate that treatment would cause disruption to their daily life. The second group of participants had expectations that treatment would involve arch wire changes, dental extractions and result in some discomfort/pain, which would cause some limited disruption to their daily life (moderate expectations). The third type of participant had expectations of the treatment process involving arch wire changes and dental extractions, and anticipated that the discomfort and pain experienced would significantly affect their daily life (marked expectations). Conclusions: These results provide the clinician with information about patient typologies and provide the clinician with some direction when communicating with their patients and managing their expectations before the start of treatment

Understanding patient expectations of health care : a qualitative study

Understanding and measuring patient expectations of health care is central to improving patient satisfaction and delivering patient-centered care. However, most empiric research in this field has focused on measuring patient expectations for specific diseases only. Patient expectations common to a variety of settings and clinical contexts need to be better understood to design measures with wider utility. We aimed to understand how patients express and conceptualize their expectations of health care across a range of clinical contexts and conditions. Semi-structured interviews were conducted with patients presenting to a major metropolitan hospital, informed by interpretive phenomenological analysis. Sampling continued until thematic saturation. Interview topics explored the illness experience, interactions with clinicians, how patients communicated and conceptualized their expectations of health care, and the nature of these expectations. The 26 participants conceptualized and described their expectations in 3 distinct domains: (1) health outcomes, (2) individual clinicians, and (3) the health-care system. Importantly, these domains were consistent across a variety of clinical contexts, participant demographics, and medical conditions. Despite variation in expectations due to individual patient circumstances, we identified 3 conceptual domains within which expectations consistently lie. When designing measurement tools for patient expectations, we suggest incorporating questions specifically addressing the 3 domains we have identified. With such measures, clinicians and health-care providers can be empowered to provide and monitor patient-centered care with outcomes tailored to what patients desire

Women's status and experiences of mistreatment during childbirth in Uttar Pradesh: a mixed methods study using cultural health capital theory.

BackgroundMistreatment of women in healthcare settings during childbirth has been gaining attention globally. Mistreatment during childbirth directly and indirectly affects health outcomes, patient satisfaction, and the likelihood of delivering in a facility currently or in the future. It is important that we study patients' reports of mistreatment and abuse to develop a deeper understanding of how it is perpetrated, its consequences, and to identify potential points of intervention. Patients' perception of the quality of care is dependent, not only on the content of care, but importantly, on women's expectations of care.MethodsThis study uses rich, mixed-methods data to explore women's characteristics and experiences of mistreatment during childbirth among slum-resident women in Uttar Pradesh, India. To understand the ways in which women's social and cultural factors influence their expectations of care and consequently their perceptions of respectful care, we adopt a Cultural Health Capital (CHC) framework. The quantitative sample includes 392 women, and the qualitative sample includes 26 women.ResultsQuantitative results suggest high levels of mistreatment (over 57 % of women reported any form of mistreatment). Qualitative findings suggest that lack of cultural health capital disadvantages patients in their patient-provider relationships, and that women use resources to improve care they receive. Participants articulated how providers set expectations and norms regarding behaviors in facilities; patients with lower social standing may not always understand standard practices and are likely to suffer poor health outcomes as a result. Of importance, however, patients also blame themselves for their own lack of knowledge.ConclusionsLack of cultural health capital disadvantages women during delivery care in India. Providers set expectations and norms around behaviors during delivery, while women are often misinformed and may have low expectations of care

Improving communication skill training in patient centered medical practice for enhancing rational use of laboratory tests: The core of bioinformation for leveraging stakeholder engagement in regulatory science.

Requests for laboratory tests are among the most relevant additional tools used by physicians as part of patient's health problemsolving. However, the overestimation of complementary investigation may be linked to less reflective medical practice as a consequence of a poor physician-patient communication, and may impair patient-centered care. This scenario is likely to result from reduced consultation time, and a clinical model focused on the disease. We propose a new medical intervention program that specifically targets improving the patient-centered communication of laboratory tests results, the core of bioinformation in health care. Expectations are that medical students training in communication skills significantly improve physicians-patient relationship, reduce inappropriate use of laboratorial tests, and raise stakeholder engagement

THE RELATIONSHIP BETWEEN PATIENT EXPECTATIONS, FUNCTIONAL OUTCOME, SELF-EFFICACY, AND REHABILITATION ADHERENCE FOLLOWING CARTILAGE REPAIR OF THE KNEE: A SEQUENTIAL EXPLANATORY ANALYSIS

Patient expectations have been shown to be a major predictor of outcomes. Furthermore, fulfilled expectations have been linked to increased patient satisfaction and rehabilitation adherence. Expectations may be influenced by a variety of factors, including patient characteristics, pre-operative function, or disease characteristics. However, it is currently unknown what factors and to what degree they may influence patient expectations prior to knee surgery. Furthermore, understanding the importance and values of those expectations for recovery using qualitative methods has not previously been conducted in this patient population. A mixed methods design was used. Twenty-one participants scheduled to undergo cartilage repair of the knee, including autologous chondrocyte implantation, osteochondral allograft transplantation, or meniscal transplant were included. During their pre-operative visit, participants completed an expectations survey (Hospital for Special Surgery (HSS) Knee Surgery Expectations Survey) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) as a measure of functional ability. At their first post-operative visit, patients completed the Self-Efficacy for Rehabilitation Scale (SER). Rehabilitation adherence was collected by the participant’s rehabilitation provider. A selected sample of 6 participants participated in a semi-structured interview 6 months following surgery to better understand their expectations for recovery. Pearson correlation coefficients were used to determine relationships between expectations and KOOS scores, SER scores, and measures of adherence. Results demonstrated that patients have moderate expectations for recovery and these expectations were positively associated with pre-operative pain, activities of daily living, and knee-related quality of life as measured by the KOOS. In addition, a negative relationship was found between patient expectations and adherence with home exercises, use of a brace, and weight-bearing restrictions. Four qualitative themes emerged as participants’ described how previous recovery experiences shaped their recovery following cartilage repair of the knee. Patient education, pre-habilitation, and the use of psychological skills during rehabilitation may help to manage patient expectations, improve rehabilitation adherence, and assist clinicians in providing more focused and individualized patient care

Preferences, predictions and patient enablement: a preliminary study

BACKGROUND: The widely used patient enablement instrument (PEI) is sometimes contrasted against measures of patient satisfaction as being a more objective measure of consultation quality, in that it is less likely to be positively influenced by fulfilling pre-existing expectations for specific consultation outcomes (such as prescriptions or referrals). However the relationship between expectation and enablement is underexplored, as is the relationship between ‘expectation’ understood as a patient preference for outcome, and patient prediction of outcome. The aims of the study are to 1) assess the feasibility of measuring the relationship between expectation fulfilment and patient enablement, and 2) measure the difference (if any) between expectation understood as preference, and expectation understood as prediction. METHODS: A questionnaire study was carried out on 67 patients attending three General Practices in the Australian Capital Territory. Patient preferences and predictions for a range of possible outcomes were recorded prior to the consultation. PEI and the actual outcomes of the consultation were recorded at the conclusion of the consultation. Data analysis compared expectation fulfilment as concordance between the preferred, predicted, and actual outcomes, with the PEI as a dependant variable. RESULTS: No statistically significant relationship was found between either preference-outcome concordance and PEI, or prediction-outcome concordance. Statistically insignificant trends in both cases ran counter to expectations; i.e. with PEI (weakly) positively correlated with greater discordance. The degree of concordance between preferred outcomes and predicted outcomes was less than the concordance between either preferred outcomes and actual outcomes, or predicted outcomes and actual outcomes. CONCLUSIONS: The relationship between expectation fulfilment and enablement remains uncertain, whether expectation is measured as stated preferences for specific outcomes, or the predictions made regarding receiving such outcomes. However the lack of agreement between these two senses of ‘patient expectation’ suggests that explicitly demarcating these concepts during study design is strongly advisable.NHMRC (National Health and Medical Research Council of Australia

"Even if the test result is negative, they should be able to tell us what is wrong with us": a qualitative study of patient expectations of rapid diagnostic tests for malaria.

BACKGROUND: The debate on rapid diagnostic tests (RDTs) for malaria has begun to shift from whether RDTs should be used, to how and under what circumstances their use can be optimized. This has increased the need for a better understanding of the complexities surrounding the role of RDTs in appropriate treatment of fever. Studies have focused on clinician practices, but few have sought to understand patient perspectives, beyond notions of acceptability. METHODS: This qualitative study aimed to explore patient and caregiver perceptions and experiences of RDTs following a trial to assess the introduction of the tests into routine clinical care at four health facilities in one district in Ghana. Six focus group discussions and one in-depth interview were carried out with those who had received an RDT with a negative test result. RESULTS: Patients had high expectations of RDTs. They welcomed the tests as aiding clinical diagnoses and as tools that could communicate their problem better than they could, verbally. However, respondents also believed the tests could identify any cause of illness, beyond malaria. Experiences of patients suggested that RDTs were adopted into an existing system where patients are both physically and intellectually removed from diagnostic processes and where clinicians retain authority that supersedes tests and their results. In this situation, patients did not feel able to articulate a demand for test-driven diagnosis. CONCLUSIONS: Improvements in communication between the health worker and patient, particularly to explain the capabilities of the test and management of RDT negative cases, may both manage patient expectations and promote patient demand for test-driven diagnoses

What e-patients want from the doctor-patient relationship: content analysis of posts on discussion boards.

People with long-term conditions are encouraged to take control and ownership of managing their condition. Interactions between health care staff and patients become partnerships with sharing of expertise. This has changed the doctor-patient relationship and the division of roles and responsibilities that traditionally existed, but what each party expects from the other may not always be clear. Information that people with long-term conditions share on Internet discussion boards can provide useful insights into their expectations of health care staff. This paper reports on a small study about the expectations that people with a long-term condition (diabetes) have of their doctors using information gleaned from Internet discussion boards