12,351 research outputs found

    Language Barriers in Health Care Settings: An Annotated Bibliography of Research Literature

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    Provides an overview of resources related to the prevalence, role, and effects of language barriers and access in health care

    Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients.

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    In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging. Summit participants specifically examined questions of who should be screened for cognitive impairment and how they should be screened in medical settings. This is important in the context of an acute illness given that the presence of cognitive impairment can have significant implications for care and for the management of concomitant diseases as well as pose a major risk factor for dementia. Participants arrived at general principles to guide future screening approaches in medical populations and identified knowledge gaps to direct future research. Key learning points of the summit included: recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition;emphasizing that any screening tool must be appropriately normalized and validated in the population in which it is used to obtain accurate information, including considerations of language, cultural factors, and education; andrecognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time

    Addressing Barriers to Medication Adherence: An Evidence-Based Screening Instrument Validation Study

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    Adherence to a prescribed medication regimen is often critical to successful disease management. Cancer diagnoses often further complicate control of the comorbid diseases. Older cancer patients with multiple comorbidities receiving chemotherapy treatment are at increased risk for adverse health outcomes from uncontrolled disease when nonadherent to their medication regimen. The intent of this pilot study was to test the validity of an evidence-based screening instrument designed to identify patients at risk for medication nonadherence and uncontrolled illness. The W-BMA (Washburn-Barrier to Medication Adherence) screening criteria were applied to retrospective data of cancer patients with multiple co-morbidities. SPSS was used to analyze the data using classification trees to compare the W-BMA screen with the current screens used in the clinic alone. The W-BMA identified a significantly larger number of patients with barriers than the current screens alone. Barriers found by the W-BMA screening instrument are strongly related to uncontrolled illness, and, these barriers are often multi-layered, impacting adherence and the health of the patient. Incidentally, there was strong evidence that patients who have barriers addressed by oncology support services (nurse navigation and social work) often fare much better than patients who do not. The instrument studied in this pilot project requires additional analysis and refinement, however, there is strong evidence that proper use of the W-BMA screening instrument used as part of a comprehensive medication adherence program may improve adherence and lower risk of uncontrolled illness and adverse events

    Addressing Distress Management Challenges: Recommendations From the Consensus Panel of the American Psychosocial Oncology Society and the Association of Oncology Social Work

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    Distress management (DM) (screening and response) is an essential component of cancer care across the treatment trajectory. Effective DM has many benefits, including improving patients’ quality of life; reducing distress, anxiety, and depression; contributing to medical cost offsets; and reducing emergency department visits and hospitalizations. Unfortunately, many distressed patients do not receive needed services. There are several multilevel barriers that represent key challenges to DM and affect its implementation. The Consolidated Framework for Implementation Research was used as an organizational structure to outline the barriers and facilitators to implementation of DM, including: 1) individual characteristics (individual patient characteristics with a focus on groups who may face unique barriers to distress screening and linkage to services), 2) intervention (unique aspects of DM intervention, including specific challenges in screening and psychosocial intervention, with recommendations for resolving these challenges), 3) processes for implementation of DM (modality and timing of screening, the challenge of triage for urgent needs, and incorporation of patient-reported outcomes and quality measures), 4) organization—inner setting (the context of the clinic, hospital, or health care system); and 5) organization—outer setting (including reimbursement strategies and health-care policy). Specific recommendations for evidence-based strategies and interventions for each of the domains of the Consolidated Framework for Implementation Research are also included to address barriers and challenges. CA Cancer J Clin 2021;71:407-436. © 2021 The Authors. CA: A Cancer Journal for Clinicians published by Wiley Periodicals LLC on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial- NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made

    Reporting health data in waiting rooms with mobile technology: Patient expectation and confirmation

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    Objectives: Hospitals and medical staff use digital devices such as mobile phones and tablets to treat patients. Prior research has examined patient-reported outcomes, and the use of medical devices to do diagnosis and prognosis of patients, but not whether patients like using, and intend to use in future, mobile devices to self-report medical data. We address this research gap by developing a theoretical model based on the expectancy confirmation model (ECM) and testing it in an empirical study of patients using mobile technology to self-report data. Design: This study adopts a non-interventional cross-sectional research design. Randomly-selected patients provided data via survey and physical measurements. The target population comprises adults visiting a healthcare laboratory to get their blood drawn. Materials and methods: We surveyed 190 randomly-selected patients waiting for treatment in the clinic. They were surveyed at two points in time - before and after their blood was drawn - on their demographic characteristics, research variables concerning their use of mobile devices to provide medical information, and perceived clinical data (blood pressure, height and weight). The research model was tested using structural equation modeling. Results: The study found strong support for the research model, with seven of eight hypotheses being supported. Both self-disclosure effort and feedback expectation positively affect both perceived feedback quality and confirmation. Contrary to expectations, perceived feedback quality was not found to affect confirmation. Perceived feedback quality, along with confirmation, was found to positively affect satisfaction, which was found to affect intention to disclose medical data through mobile technology. Conclusions: The study\u27s findings support the proposed path from feedback expectation and self-disclosure effort to confirmation to satisfaction to disclosure intention. Although perceived feedback does not affect confirmation, it affects satisfaction. Overall, we believe the results provide novel insights to both scientific research community and practitioners about using mobile technologies for self-reporting medical data

    Effectiveness of interventions to improve medication adherence in adults with depressive disorders: a meta-analysis

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    Trastorno depresivo mayor; Metanálisis; Adherencia al tratamientoTrastorn depressiu major; Metaanàlisi; Adherència al tractamentMajor depressive disorder; Meta-analysis; Treatment adherenceBackground Non-adherence to medication is a major obstacle in the treatment of depressive disorders. We systematically reviewed the literature to evaluate the effectiveness of interventions aimed at improving adherence to medication among adults with depressive disorders with emphasis on initiation and implementation phase. Methods We searched Medline, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Social Science Citation Index and Science Citation Index for randomized or non-randomized controlled trials up to January 2022. Risk of bias was assessed using the criteria of the Cochrane Collaboration. Meta-analyses, cumulative and meta-regression analyses for adherence were conducted. Results Forty-six trials (n = 24,324) were included. Pooled estimate indicates an increase in the probability of adherence to antidepressants at 6 months with the different types of interventions (OR 1.33; 95% CI: 1.09 to 1.62). The improvement in adherence is obtained from 3 months (OR 1.62, 95% CI: 1.25 to 2.10) but it is attenuated at 12 months (OR 1.25, 95% CI: 1.02 to 1.53). Selected articles show methodological differences, mainly the diversity of both the severity of the depressive disorder and intervention procedures. In the samples of these studies, patients with depression and anxiety seem to benefit most from intervention (OR 2.77, 95% CI: 1.74 to 4.42) and collaborative care is the most effective intervention to improve adherence (OR 1.88, 95% CI: 1.40 to 2.54). Conclusions Our findings indicate that interventions aimed at improving adherence to medication among adults with depressive disorders are effective up to six months. However, the evidence on the effectiveness of long-term adherence is insufficient and supports the need for further research efforts.This study has been funded by Instituto de Salud Carlos III through the project "PI18/00767" (Co-funded by European Regional Development Fund/European Social Fund "A way to make Europe"/"Investing in your future")
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