Behaviorism and the concepts of influencing the attitudes of patients towards health behaviors

Health professionals in primary care teams need to know how to effectively encourage patients to change health behaviors to achieve treatment goals. Understanding the behavioral patterns and psychological underpinnings of making changes can help healthcare professionals deliver interventions with a higher success rate. The aim of the study was to assess the importance of behavior patterns in shaping patients' health attitudes and behaviors. There are three types of theoretical models that explain how health behaviors are initiated and changed: motivational, post-intentional, and multistage models. Motivation models describe the role of individual cognitive variables in the process of creating the intention to change behavior. Changing habits in the context of health promotion takes place by influencing the perception of patients. This can be achieved using the TRA (Theory of Reasoned Action), TBP (Theory of Planned Behavior) and HBM (Health Belief Model) models by convincing the public about susceptibility to a given disease, disseminating knowledge about effective methods of prevention and generating persuasion, support, admiration or recognition in society after positive behaviors such as smoking cessation or regular physical activity. Post-intentional models indicate factors that increase the chance of translating motivation into action. They commit the individual to a certain action when certain environmental circumstances are met, thus helping to translate the intention of the goal into action. Multi-stage models describe health behaviors as involving several separate stages. These theories are based on the assumption that people at different stages will behave differently, so the types of interventions and information needed to change behavior will vary depending on the stage they are at. Helping patients set realistic goals, such as moving to the next stage, can facilitate the change process. Effective behavioral interventions must be based on changing the approach of medical staff to the interpersonal process with the patient. This approach should be patient-centred and collaborative. Medical staff should assess the importance that the patient attaches to his health and the treatment process, and thus also the willingness and motivation to comply with the recommendations. Merely providing information will not guarantee a change in their behavior. Healthcare professionals should use active listening techniques (using open-ended questions, explanations, reflective and summarizing statements), should encourage patients to express concerns, and should be able to weigh the pros and cons of different treatment approaches

Istota kwestionariusza przeglądu lekowego farmaceuty z perspektywy koordynowanej opieki zdrowotnej

In the pharmaceutical care the pharmacist cooperates with other representatives of the medical professions and caters the patient with holistic care. The pharmacist concentrates on identifying and solving drug problems. The tool that makes the process feasible is the pharmaceutical patient questionnaire. Introducing this pharmaceutical patient questionnaire is the main goal of the paper. This research investigates the issue of defining and creating pharmaceutical patient questionnaire, which can be used in coordinated pharmaceutical care process. The paper shows an original concept created by Medical and Diagnostical Center in Siedlce, Poland (MCD). In the research and analysis process the authors of the study have created an original concept of pharmaceutical patient questionnaire, which can be used in coordinated pharmaceutical care process in Poland. The pharmaceutical patient questionnaire comprises the following information:  patient’s personal data, patient’s subjective feelings concerning his health, different illnesses, allergies, vaccinations, preventive medical examinations and other basic medical indicators or parameters. At the core of the pharmaceutical patient questionnaire is the information on the type of medicine used taken by the patient, the name of the medicine, the doses, effectiveness of the therapy, side effects and own patient’s medicine supplies. This tool also comprises information on pharmacist- patient interview, the pharmacist’s recommendation and other concerning information.   Identification and reinforcement of the scope of information provided in the frame of pharmaceutical patient questionnairemay have a crucial influence on implementing and conducting coordinated pharmaceutical care.Idea opieki farmaceutycznej zakłada ścisłą współpracę farmaceuty z przedstawicielami innych profesji medycznych w celu objęcia pacjenta holistyczną opieka zdrowotną. Zadaniem farmaceuty jest rozpoznawanie oraz proponowanie rozwiązań w zakresie problemów i interakcji lekowych. Realizacji tego procesu nie byłaby możliwa bez odpowiednich narzędzi. W ramach niniejszej pracy zaprezentowano istotę i zakres kwestionariusza przeglądu lekowego farmaceuty. Kwestionariusz ten jest autorskim narzędziem stworzonym w oparciu o doświadczenie i praktykę medyczno-biznesową podmiotu leczniczego Centrum Medyczno-Diagnostyczne w Siedlcach. Kwestionariusz przeglądu lekowego farmaceuty umożliwia zbieranie następujących informacji: dane osobowe pacjenta, subiektywne odczucia pacjenta dotyczące jego stanu zdrowia, informacje o chorobach, alergiach, szczepieniach, badaniach okresowych i prewencyjnych oraz inne dodatkowe dane medyczne. Istotną częścią kwestionariusza jest blok informacji dot. farmakoterapii, w tym rodzaju i typie leków przyjmowanych przez pacjenta, dawkowaniu, efektywności terapii, działaniach niepożądanych związanych z przyjmowaniem produktów leczniczych oraz zasobach lekowych pacjenta. Prezentowane narzędzie zawiera także dodatkowe informacje bazujące na wywiadzie z pacjentem oraz odpowiednie zalecenia farmaceuty. Prawidłowa identyfikacja oraz poszerzenie zakresu informacji zawartych w ramach kwestionariusza przeglądu lekowego farmaceuty ma kluczowe znaczenie dla implementacji oraz realizacji koordynowanej opieki zdrowotnej, uwzgledniającej aspekt opieki farmaceutycznej

Doświadczenia międzynarodowe w kontekście wdrożenia opieki farmaceutycznej w Polsce

The Pharmacist Profession Act and planned pharmaceutical services introduce many changes in community pharmacies, which require effective and efficient implementation. The below article aimed to analyse international experiences in the field of pharmaceutical care and to identify solutions that could be implemented in Poland. United States, United Kingdom, the Netherlands, Sweden, Austria and Australia were considered. These countries were analysed in terms of which pharmaceutical care services are provided, how pharmaceutical care was firstly introduced, what compensation pharmacists receive for additional services and what IT systems are used.Ustawa o zawodzie farmaceuty oraz świadczenia planowane w ramach opieki farmaceutycznej w Polsce wprowadzą szereg zmian w funkcjonowaniu aptek ogólnodostępnych, które wymagają skutecznego i efektywnego wdrożenia. Celem niniejszej pracy była analiza doświadczeń międzynarodowych w zakresie opieki farmaceutycznej oraz poszukiwanie rozwiązań, które byłyby możliwe do zaimplementowania w Polsce. Analizie poddano zakresy świadczeń udzielanych w ramach opieki farmaceutycznej w Stanach Zjednoczonych, Wielkiej Brytanii, Królestwie Niderlandów, Szwecji, Austrii i Australii. Kraje te przeanalizowano pod kątem zakresu świadczonych usług w ramach opieki farmaceutycznej, przebiegu wdrożenia opieki farmaceutycznej, premiowania farmaceutów za świadczenie dodatkowych usług oraz pod kątem oceny systemu IT.  &nbsp

Zakres i metody pomiaru efektywności ambulatoryjnej opieki zdrowotnej

Effectiveness of medical care is one of the most reliable parameters to assess individual aspects of the health care system. However, it should be emphasized that there is no unified definition of effectiveness in health care, on the basis of which these aspects can be assessed and compared. The aim of the study was to draw attention to the inability to make a reliable and authoritative assessment of effectiveness in health care due to the lack of a uniform definition and to emphasize their importance in the light of international comparative analysis. A review of the literature relating to the assessment of the quality and effectiveness of services provided by healthcare entities was performed. It has been defined that efficiency grows as the quality of healthcare increases and/or the cost of healthcare decreases, and effectiveness measurement should refer to a specific member of a medical stuff

Factors Differentiating Rural and Urban Population in Determining Anxiety and Depression in Patients with Chronic Cardiovascular Disease: A Pilot Study

The aim of this cross-sectional study was to analyze selected variables differentiating rural from urban populations, as well as identify potentially increased levels of depression and anxiety in patients with chronic cardiovascular disease. The study was carried out in 193 patients. The study used the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS), the Health Behavior Inventory Questionnaire (HBI), the WHOQOL-BREF Quality of Life Questionnaire, and the Hospital Anxiety and Depression Scale–Modified Version (HADS-M). Spearman’s rank correlation coefficient test and logistic regression were used for analyses. In rural patients, we observed a relationship between anxiety and age (1/OR = 1.04; 95% CI: 0.91–0.99), the assessment of satisfied needs (1/OR = 293.86; 95% CI: 0.00001–0.56), and quality of life (QoL) in physical (OR = 1.56; 95% CI: 1.11–2.33), social (1/OR = 1.53; 95% CI: 0.04–0.94), and environmental domains (OR = 1.67; 95% CI: 1.06–3.00), as well as between depression and QoL in physical (1/OR = 1.39; 95% CI: 0.50–0.97) and psychological (OR = 1.37; 95% CI: 1.01–1.93) domains. In city patients, we observed a relationship between the drug and Qol in the physical (1/OR = 1.25; 95% CI: 0.62–0.98) and psychological (OR = 1.49; 95% CI: 1.13) domains. Younger patients living in a rural area with a lower assessment of met needs, a higher level of QoL in physical and environmental domains, and a lower social domain, as well as patients living in a city with a lower QoL in the physical domain and a higher psychological domain, have a greater chance of developing anxiety and depressive disorders

Increased accessibility to primary health care due to nurse prescribing of medicines

Since January 2016, nurses and midwives in Poland have had the right, with some restrictions, to prescribe medicines. Consequently, Polish patients received the same opportunity as in other countries worldwide: easier access to certain health services, i.e., medical prescribing. The aim of this study was to assess the impact of structural changes which increased the nurses’ competences on the accessibility to prescription visits for patients receiving primary healthcare on the example of Medical and Diagnostic Centre (MDC), and to discuss the general trend of legal changes in nursing profession regulations. We performed a detailed analysis of the data on the MDC patient population in Siedlce who received at least one prescription written by a general practitioner and/or a nurse/midwife in the years 2017–2019.The largest number of prescription visits made by nurses concerned patients aged 50–70 years, as this age range includes the largest number of patients with chronic diseases who need continued pharmacological treatment originally administered by doctors. An increasing tendency for prescription visits made by nurses was recorded, with a simultaneous downward trend in the same type of visits undertaken by doctors at MDC. Nurses’ involvement in prescribing medications as a continued pharmacotherapy during holiday seasons results in patients having continuous access to medication. An upward trend was also observed in the number of medications prescribed by nurses per patient. Structural changes in the legal regulations of the nursing profession improve patients’ access to prescription visits under primary healthcare. Further research is recommended to evaluate the dynamics of these trends and the impact of newly introduced nursing competences on the accessibility of prescription visits for patients

Needs, Aggravation, and Degree of Burnout in Informal Caregivers of Patients with Chronic Cardiovascular Disease

This study aimed to answer three main questions with respect to home caregivers for people with cardiovascular disease: (1) Are the needs of home caregivers being met (and at what level)?; (2) what is the level of emotional exhaustion, depersonalization, and personal accomplishment of home caregivers?; (3) what sociodemographic variables of home caregivers are related to unmet needs and level of emotional exhaustion, depersonalization, and personal accomplishment? The study used the Camberwell Modified Needs Assessment questionnaire and the Maslach Burnout Inventory questionnaire. This study reports on 161 informal home caregivers of patients with cardiovascular disease. We found that younger caregivers were less likely to report unmet needs (p = 0.011), and showed lower rates of burnout on depersonalization and emotional exhaustion. In addition, caregivers who worked more often reported higher levels of met needs (p = 0.022), and showed lower rates of burnout on depersonalization (p = 0.005) and emotional exhaustion (p = 0.018). Subjects residing in urban areas were more likely to report unmet needs (p = 0.007), and showed higher rates of burnout on emotional exhaustion (p = 0.006). Older caregivers who are unemployed and reside in cities should be offered programs to determine their unmet needs and to receive support

An overview of factors influencing cancer screening uptake in primary healthcare institutions

Screening significantly decreases the severity and incidence of conditions, as well as mortality, and therefore can improve the health of the population. Screening in Poland falls below the acceptable level of 45% of organised screening uptake and the recommended level of 65%. Multidimensional factors have been implicated as barriers and facilitators of screening uptake in the primary care setting. This paper summarises the existing evidence on factors influencing screening uptake in a Pap smear for cervical cancer (CC), mammography screening for breast cancer and faecal occult blood test (FOBT) for colorectal cancer (CRC). We performed a literature search in the MEDLINE (PubMed) and EMBASE databases and included articles of any study design published between 2010 and 2020. We also demonstrate the original concept of ‘Ugly Value’, which describes factors that may reduce screening uptake. Primary care practitioners play a vital role in increasing screening rates in the populations and can improve these rates through a variety of systematically implemented strategies and interventions. We determine four areas to improve cancer screening uptake in primary healthcare institutions: data gathering and data use (IT systems, meaningful use of Electronic Health Records to generate reminders, prompting healthcare professionals to refer patients for screening), cost effectiveness (avoiding overuse of screening in low-risk populations), innovative efficient management (use of effective interventions and thoughtful allocation of resources, e.g. engaging nurses into patient navigation instead of assigning them to answer patient concerns about screening by telephone), organisational system (team based, integrated care and patient navigation are ways to improve screening rates)

Analiza profilaktycznych badań bilansowych dla osób dorosłych w Polsce - wstępne wyniki

Background: Periodic health examinations for adult persons are one of the basic components of the pilot study of coordinated health care in primary health care in Poland. It was recommended as the result of the project “Preparation, testing and implementation of the organization of coordinated care to the health care system (CC O)” (EU project – Operational Programme Knowledge Education Development). Aim of the study: To assess the preliminary clinical results and resource use of pilot periodic health examinations in adults as a tool for performing prevention tasks in coordinated health care Polish PHC entity. Material and methods: Periodic health examinations were performed in 13 PHC outpatient clinics (3 urban and 10 rural areas) by PHC teams comprised of 22 PHC physicians, eight nurses, seven medical receptionists, and one nutritionist. Enrollment included 122 patients (median age of 45, range: 18–65). The examinations were performed according to the questionnaire, which includes 135 patient variables: personal data, detailed patient interview, anthropometric measurements, physical examination, diagnostic results, conclusions, and patient health status. Results: For this study, 71 women (58%) and 51 men (42%) were participants. As a result of the periodic health examinations, the following diagnoses were observed: one cholelithiasis case (2.4%), 36 incidences of hypercholesterolemia (85.7%), one case of diabetes mellitus type 2 (2.4%), one patient with hypothyroidism (2.4%; TSH 17.78), and three incidences of nephrolithiasis (7.1%). Increased risk of cardiovascular disease was found in six patients. Oncological diagnostics was advised to three patients. A risk of depression was observed in 12 patients. A strong addiction to nicotine was seen in four patients while an increased alcohol addiction risk was found in 19 patients. Conclusions: Periodic health examinations in adults as a preventive measure might be useful and feasible for PHC teams in centers with basic health care coordination. However, the proposed periodic health examinations program requires further investigation in various populations and in entities with different levels of health care coordination.Wstęp: Profilaktyczne badania bilansowe dla osób dorosłych są jednym z podstawowych elementów pilotażowego badania Opieki Koordynowanej w podstawowej opiece zdrowotnej w Polsce. Rekomendacja badań jest wynikiem prac przeprowadzonych w ramach projektu „Przygotowanie, testowanie i wdrażanie organizacji skoordynowanej opieki dla systemu opieki zdrowotnej (OOK)” (Projekt UE – Program Operacyjny Wiedza Edukacja Rozwój). Cel pracy: Wskazanie wstępnych wyników uzyskanych w pilotażu badań bilansowych u dorosłych oraz możliwości realizacji prewencji w zaproponowanym schemacie w warunkach polskiej POZ. Materiał i metody: Bilanse prowadzono w 13 przychodniach POZ, w 3 placówkach miejskich i 10 na terenach wiejskich, w ramach prac zespołów POZ. Badaniami objęto 122 pacjentów (mediana wieku 45, zakres: 18–65). Narzędzie badań stanowił kwestionariusz bilansowy określający 135 zmiennych w domenach: dane personalne, szczegółowy wywiad z pacjentem, pomiary antropometryczne, badanie fizykalne, wyniki badań diagnostycznych, konkluzje oraz status zdrowotny pacjenta. Wyniki: 71 kobiet (58%) and 51 mężczyzn (42%) uczestniczyło w badaniu. Wskutek badań bilansowych postawiono od razu następujące diagnozy w gabinecie lekarza POZ: kamica żółciowa – 1 przypadek (2,4%), hipercholestrolemia – 36 (85,7%), cukrzyca typu II – 1 (2,4%), niedoczynność tarczycy (TSH 17,78) – 1 (2,4%), kamice nerkowe – 3 (7,1%). Wydano 3 karty DILO z podejrzeniem nowotworów. Zidentyfikowano 6 pacjentów z dużym ryzykiem sercowo-naczyniowym, 12 pacjentów obciążonych dużym ryzykiem wystąpienia depresji, 4 pacjentów z silnym uzależnieniem od nikotyny oraz 19 pacjentów zagrożonych w znacznym stopniu problemem alkoholowym. Wnioski: Badania bilansowe u dorosłych w zaproponowanym schemacie wydają się być formą prewencji możliwą do realizacji przez zespoły POZ w ośrodkach o elementarnym stopniu koordynacji. Proponowany schemat badań bilansowych wymaga jednak dalszych obserwacji w liczniejszej populacji i ośrodkach o zróżnicowanym stopniu koordynacji opieki zdrowotnej