Patterns of analgesic use, pain and self-efficacy: a cross-sectional study of patients attending a hospital rheumatology clinic

Background: Many people attending rheumatology clinics use analgesics and non-steroidal anti-inflammatories for persistent musculoskeletal pain. Guidelines for pain management recommend regular and pre-emptive use of analgesics to reduce the impact of pain. Clinical experience indicates that analgesics are often not used in this way. Studies exploring use of analgesics in arthritis have historically measured adherence to such medication. Here we examine patterns of analgesic use and their relationships to pain, self-efficacy and demographic factors. Methods: Consecutive patients were approached in a hospital rheumatology out-patient clinic. Pattern of analgesic use was assessed by response to statements such as 'I always take my tablets every day.' Pain and self-efficacy (SE) were measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Arthritis Self-Efficacy Scale (ASES). Influence of factors on pain level and regularity of analgesic use were investigated using linear regression. Differences in pain between those agreeing and disagreeing with statements regarding analgesic use were assessed using t-tests. Results: 218 patients (85% of attendees) completed the study. Six (2.8%) patients reported no current pain, 26 (12.3%) slight, 100 (47.4%) moderate, 62 (29.4%) severe and 17 (8.1%) extreme pain. In multiple linear regression self efficacy and regularity of analgesic use were significant (p < 0.01) with lower self efficacy and more regular use of analgesics associated with more pain. Low SE was associated with greater pain: 40 (41.7%) people with low SE reported severe pain versus 22 (18.3%) people with high SE, p < 0.001. Patients in greater pain were significantly more likely to take analgesics regularly; 13 (77%) of those in extreme pain reported always taking their analgesics every day, versus 9 (35%) in slight pain. Many patients, including 46% of those in severe pain, adjusted analgesic use to current pain level. In simple linear regression, pain was the only variable significantly associated with regularity of analgesic use: higher levels of pain corresponded to more regular analgesic use (p = 0.003). Conclusion: Our study confirms that there is a strong inverse relationship between self-efficacy and pain severity. Analgesics are often used irregularly by people with arthritis, including some reporting severe pain

Physician-patient communication in rheumatology: a systematic review

The nature of physician–patient interaction can have a significant impact on patient outcomes through information-sharing and disease-specific education that can enhance patients’ active involvement in their care. The aim of this systematic review was to examine all the empirical evidence pertaining to aspects of physician–patient communication and its impact on patient outcomes. A systematic search of five electronic databases (MEDLINE, PsycINFO, EMBASE, CINAHL, and Web of Science) was undertaken from earliest record to December 2016. Studies were eligible if they: (1) included adult participants (18 years or over) with a diagnosis of a rheumatic condition; (2) were of quantitative, qualitative or mixed methods design; (4) were surveys, observational and interventional studies; (5) were published in the English language; and (6) reported findings on either various physician–patient communication aspects alone or in combination with physical and psychological outcomes. Searches identified 455 papers. Following full-text retrieval and assessment for eligibility and quality, ten studies were included in the review; six quantitative, one mixed methods, and three qualitative papers. Higher levels of trust in the physician and active patient participation in the medical consultation were linked to lower disease activity, better global health, less organ damage accrual, greater treatment satisfaction with fewer side effects from the medication, more positive beliefs about control over the disease, and about current and future health. Future research could focus on the design and implementation of interventions incorporating communications skills and patient-education training

Community exchange: Social software to support group discussion

Aim of this project is to design a web application that supports a community in discussing a complex issue such as energy consumption and climate change. The main focus here is to design a platform that allows community members to communicate via a technology intervention that enhances social interactions in a normal community conversation context and to assist with making discussion more effective especially in creating and sharing content to support understanding. It provides the important benefit of community members receiving support and information from others, especially as it encourages and increases community engagement in the discussion to support their behaviour change. To bring about behaviour change in the community, the application help presented the ecological argument for reducing power consumption and to support sharing of experiences between community members. In response to our observations in the face-to-face discussion, we designed a sharing and communication application, Energymark social software (ESS), to improve a social group's sharing of information, tips and experiences. ESS provides communication and social awareness tools, which enable users to build conversations in the context of shared content and browse their social networks. Final responses to ESS from a focus group and the deployment of the system to test users have been positive where results from open-ended questionnaire and focus group study, we found that usability of the implemented social software does related to the engagement of users and active participation of users in a long term does contribute to their behaviour change in reducing energy usage and climate change

Observation for innovation

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Finding Patterns in the Fieldwork

This paper considers the potential of using patterns of cooperative interaction to support the development of general design principles drawn from a range of work settings. It reports on the development of patterns from ethnographic studies in a number of work environments. Our particular interest is in the possibilities surrounding the use of patterns as a means of organising, presenting and representing this growing corpus of ethnographic material and in the contribution this might make to CSCW design. In this paper we focus on outlining some of our experiences and difficulties in developing patterns from ethnographic studies and present some initial ideas towards the development of a pattern language to exploit the experience gained from a decade of field studies