Patients' perceived health service needs for osteoarthritis (OA) care: a scoping systematic review

OBJECTIVE: To identify and synthesise evidence regarding patients' perceived health service needs related to osteoarthritis (OA). DESIGN: A comprehensive systematic scoping review of MEDLINE, PsycINFO, EMBASE and CINAHL (1990-2016) was performed to capture information regarding patient perceived health service needs related to OA. Risk of bias and quality of included articles were assessed. Relevant data were extracted and collated to provide a systematic review of the existing literature. RESULTS: Of the 1384 identified manuscripts, 21 were relevant to areas of patient perceived need, including needs related to medical care, pharmacologic therapy, physiotherapy and exercise therapy and alternative medicine. Key findings included (1) Symptom control drove the need for both conventional and complementary services. (2) An individualized relationship was sought with a practitioner knowledgeable in OA care and who adopted a holistic approach, whether providing conventional or alternative therapies. (3) Medications were required to obtain symptomatic relief, with use tempered by recognition of potential side effects and financial cost. (4) The need for allied health services was recognised, although patient and system issues were barriers to uptake. (5) Patient's attitudes towards joint replacement, orthoses and physical aids were influenced by patient preferences and previous healthcare experiences. CONCLUSION: Patient perceived needs are similar to those suggested by clinical guideline recommendations. Better aligning patient perceived needs with healthcare requirements may improve OA outcomes and optimise healthcare system utilisation

Patients’ perceived needs for medical services for non-specific low back pain: A systematic scoping review

Background: An improved understanding of patients’ perceived needs for medical services for low back pain (LBP) will enable healthcare providers to better align service provision with patient expectations, thus improving patient and health care system outcomes. Thus, we aimed to identify the existing literature regarding patients’ perceived needs for medical services for LBP. Methods: A systematic scoping review was performed of publications identified from MEDLINE, EMBASE, CINAHL and PsycINFO (1990–2016). Descriptive data regarding each study, its design and methodology were extracted and risk of bias assessed. Aggregates of patients’ perceived needs for medical services for LBP were categorised. Results: 50 studies (35 qualitative, 14 quantitative and 1 mixed-methods study) from 1829 were relevant. Four areas of perceived need emerged: (1) Patients with LBP sought healthcare from medical practitioners to obtain a diagnosis, receive management options, sickness certification and legitimation for their LBP. However, there was dissatisfaction with the cursory and superficial approach of care. (2) Patients had concerns about pharmacotherapy, with few studies reporting on patients’ preferences for medications. (3) Of the few studies which examined the patients’ perceived need of invasive therapies, these found that patients avoided injections and surgeries (4) Patients desired spinal imaging for diagnostic purposes and legitimation of symptoms. Conclusions: Across many different patient populations with data obtained from a variety of study designs, common themes emerged which highlighted areas of patient dissatisfaction with the medical management of LBP, in particular, the superficial approach to care perceived by patients and concerns regarding pharmacotherapy. Patients perceive unmet needs from medical services, including the need to obtain a diagnosis, the desire for pain control and the preference for spinal imaging. These issues need to be considered in developing approaches for the management of LBP in order to improve patient outcomes

Patients’ perceived health information needs in inflammatory arthritis: A systematic review

Objectives: To identify the breadth of the literature regarding patients’ perceived health information needs related to inflammatory arthritis care. Methods: A systematic scoping review of MEDLINE, EMBASE, CINAHL and PsycINFO was performed to identify relevant articles (1990 -2016) examining patients’ perceived needs relating to health information in inflammatory arthritis. Data and themes were identified and categorised and risk of bias assessed. Results: Twenty nine studies (11 quantitative, 14 qualitative and 4 mixed methods) from 4121 identified articles were relevant for inclusion. Most focussed on rheumatoid arthritis. Key findings included: (1) Reasons for seeking health information often focussed on gaining ownership over their condition and facilitating self-management. (2) Demographic differences in information needs were inconsistent, but women and younger patients generally reported more needs. (3) Desired information content was broad, and included targeted and practical information covering disease treatment and psychosocial wellbeing. (4) Preferred information delivery method was consultation with a Rheumatologist; however group sessions had advantages for psychosocial issues while written information provided useful supplementation. (5) Barriers to meeting health information needs were around timely access. Conclusions: Patients with inflammatory arthritis have high information needs, desiring practical and individualised information. When developing strategies to meet patients’ information needs, aligning patient expectations with delivery methods that are accessible, cost-effective and flexible may help to optimize patient outcomes

Patients' perceived needs of osteoarthritis health information: A systematic scoping review

Background: Optimal management of osteoarthritis requires active patient participation. Understanding patients’ perceived health information needs is important in order to optimize health service delivery and health outcomes in osteoarthritis. We aimed to review the existing literature regarding patients’ perceived health information needs for OA. Methods: A systematic scoping review was performed of publications in MEDLINE, EMBASE, CINAHL and PsycINFO (1990–2016). Descriptive data regarding study design and methodology were extracted and risk of bias assessed. Aggregates of patients’ perceived needs of osteoarthritis health information were categorized. Results: 30 studies from 2876 were included: 16 qualitative, 11 quantitative and 3 mixed-methods studies. Three areas of perceived need emerged: (1) Need for clear communication: terms used were misunderstood or had unintended connotations. Patients wanted clear explanations. (2) Need for information from various sources: patients wanted accessible health professionals with specialist knowledge of arthritis. The Internet, whilst a source of information, was acknowledged to have dubious reliability. Print media, television, support groups, family and friends were utilised to fulfil diverse information needs. (3) Needs of information content: patients desired more information about diagnosis, prognosis, management and prevention. Conclusions: Patients desire more information regarding the diagnosis of osteoarthritis, its impact on daily life and its long-term prognosis. They want more information not only about pharmacological management options, but also non-pharmacological options to help them manage their symptoms. Also, patients wanted this information to be delivered in a clear manner from multiple sources of health information. To address these gaps, more effective communication strategies are required. The use of a variety of sources and modes of delivery may enable the provision of complementary material to provide information more successfully, resulting in better patient adherence to guidelines and improved health outcomes

Patient-perceived health service needs in inflammatory arthritis: A systematic scoping review

Background: Care that is patient-centred is more likely to be sustainable and associated with improved health outcomes. This approach to care requires an understanding of patients' health service needs, yet few studies have directly investigated the perceived health service needs of people with inflammatory arthritis. Objectives: To systematically identify the existing literature relating to patient perceived health service needs for inflammatory arthritis. Methods: A systematic review of MEDLINE, EMBASE, CINAHL, and PsycINFO was conducted (1990-2016). Studies examining patients' perceived needs relating to health services for inflammatory arthritis were identified. Descriptive data regarding study design and methodology were extracted and risk of bias assessed. Findings were collated and categorized thematically. Results: In total, 27 of 1405 (16 qualitative, 9 quantitative, and 2 mixed-methods) studies were relevant. The main areas of perceived need related to (1) Communication: consumers wanted clear, empathic communication, and to be involved with decision-making. (2) Characteristics of ongoing care: adequate consultation length with continuity and timely care were valued. (3) Factors influencing care-seeking included individual attitudes, disease severity, finances and family expectations. (4) Allied health and complementary and alternative medicines (CAM) were perceived as useful by many. The reporting of CAM use to doctors was variable, with several factors contributing to under-reporting. Conclusions: This review identified patients' perceived needs for better communication with their health providers, the heterogeneity of influences determining when care is sought and preferences regarding non-pharmacologic therapies. Aligning patients' perceived needs with evidence-based therapy for people with inflammatory arthritis will be important in optimizing patient outcomes

A systematic review of consumer' perceived needs of health services related to osteoarthritis

Purpose: Osteoarthritis (OA), the most common cause of severe long-term pain and physical disability, is expected to be the fourth leading cause of disability by 2020. This will place a significant burden on health care and compromise quality of life. Effective management of OA requires active patient participation and involvement in management decisions. As health systems strive to provide consumer-centered care, it is important to identify consumers’ perceived needs regarding health care, to enable better matched service provision. The aim of this systematic review was to identify perceived needs relating to health services in people with OA. Methods: The published literature, indexed in MEDLINE, EMBASE, PsycINFO and CINAHL from 1990 - May 2015, was searched to identify patient perceived (i.e. the consumer perspective) health services needs related to OA. To capture all aspects of health services, the search included MeSH terms and text words comprehensively covering different health care providers, forms of health care, health care environments, barriers to care and access issues. A manual search of references related to potentially relevant review articles was also performed. Manuscripts were included if they provided information for people with, or with an interest in OA, regarding consumer perceived needs related to health services.Results: The combined search strategy returned 1051 papers, of which 16 articles were identified as relevant after limiting to English. Most of these studies were from the United Kingdom, United States of America or Australia. The majority of participants were recruited from general practice or subspecialty outpatient clinics and most studies involved only people with OA. Eight key themes emerged from the included studies relating to perceived health service needs of patients with OA: 1) patient-physician interaction, 2) pharmacologic therapy and pain management, 3) physiotherapy and exercise therapy, 4) complementary and alternative medicine (CAM), 5) joint replacement surgery, 6) access and waiting times, 7) health system interface and 8) other service needs. Whilst few studies focused on the study question, we were able to identify a number of important and consistent issues. Central to our findings was that patient motivation for seeking health services was predominantly driven by the desire for symptomatic relief and improved quality of life. Emphasis was placed on the need for health services to be disease-specific, effective and convenient in terms of mode of treatment and accessibility to the patient. Key aspects of desired health services included a multi-modal approach, including pharmacological management from a primary care physician and non-pharmacological therapies, such as physical therapy, and help addressing the psychosocial factors related to their condition. Patients expressed a need for help in coping with pain, disability, and the social and emotional impact of their disease. These areas were perceived as important in optimizing quality of life and function. Patients viewed a number of health services positively, with different health care providers providing complementary roles in management of OA. Conclusions: Health service use is driven by patient perceived need. As patients should be active participants in managing their OA, taking their perceived needs relating to health services into account when providing care is critical to enable coordinated, effective management of OA. This may enable better matching of health care and health information provision by service providers with patient perceived health care needs. Results of this systematic review have the potential to guide the direction of further work, and inform the provision of relevant services for those with OA, with the view to improving patient satisfaction, compliance, service and optimizing patient outcomes

People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies:a systematic review

Question: What health information needs are perceived by people with low back pain? Design: Systematic review of publications examining perceived health information needs related to low back pain identified through Medline, EMBASE, CINAHL and PsycINFO (1990 to 2018). Participants: Adults with low back pain of any duration. Data extraction and analysis: Two reviewers independently extracted descriptive data regarding study design and methodology, and assessed risk of bias. Aggregated findings of the perceived needs of people with low back pain regarding health information were meta-synthesised. Results: Forty-one studies (34 qualitative, four quantitative and three mixed-methods) were identified. Two major areas of perceived health information needs for low back pain emerged. The first major area was needs related to information content: general information related to low back pain, its cause and underlying pathology; strong desire for diagnosis and imaging; prognosis, future disability and effect on work capacity; precipitants and management of flares; general management approaches; self-management strategies; prevention; and support services. The second major area of needs related to how the information was delivered. People with low back pain wanted clear, consistent information delivered in suitable tone and understandable language. Conclusion: Available data suggest that the information needs of people with low back pain are centred around their desire for a diagnosis, potentially contributing to expectations for and overuse of imaging. People with low back pain expressed a strong desire for clear, consistent and personalised information on prognosis, treatment options and self-management strategies, related to healthcare and occupational issues. To correct unhelpful beliefs and optimise delivery of evidence-based therapy, patient and healthcare professional education (potentially by an integrated public health approach) may be warranted

Overview of studies.

<p>Overview of studies.</p