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

TL;DR: 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 are identified.
About: This article is published in Seminars in Arthritis and Rheumatism.The article was published on 2017-10-30 and is currently open access. It has received 18 citations till now. The article focuses on the topics: Evidence-based practice & CINAHL.

Summary (5 min read)

Introduction

  • Care that is patient-centred is more likely to be sustainable and associated with improved health outcomes, also known as Background.
  • To systematically identify the existing literature relating to patient perceived health service needs for inflammatory arthritis.
  • A systematic review of MEDLINE, EMBASE, CINAHL and PsycINFO was conducted (1990–2016), also known as Methods.
  • 27 of 1405 (16 qualitative, 9 quantitative and 2 mixed-methods) studies were relevant, also known as Results.
  • 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.

BACKGROUND

  • The inflammatory arthritides are a heterogeneous group of diseases associated with significant morbidity, mortality and healthcare costs.
  • (1) Appropriate clinical management has been shown to improve health care outcomes, limit significant interference with function and ability to perform daily activities and improve quality of life.
  • Relative to the vast majority of chronic health conditions that are more prevalent with ageing, inflammatory arthritis typically affects younger people, most often when their careers, relationships and families are commencing.
  • While there are numerous studies, which have reported factors that are perceived as important to patients (or ‘needs’) in the management of their inflammatory arthritis,(28) a systematic identification and appraisal of these data has not been undertaken previously; this has been identified as a priority(29) and an essential first step towards optimizing the use of often limited health resources.
  • One of the most important domains of patient-centered care is determining the patient’s perspective as it related to their perceived needs from health services.

METHODS

  • The authors review question was intentionally broad in order to synthesise a predicted wide breath of literature relating to patients’ health service needs.
  • This approach was performed to capture the breadth of the topic to enable a comprehensive exploration of the patients’ perspective, map the existing literature and to identify gaps in the evidence.
  • A comprehensive search strategy to identify evidence relative to needs related to health services was developed iteratively by a multidisciplinary team involving clinician researchers (Rheumatologists and Physiotherapists), a patient representative and an academic librarian.
  • Only full text studies written in English were included.
  • The full text for articles that appeared to meet inclusion criteria were retrieved and assessed for relevance (JS).

Data analysis and synthesis

  • One investigator (JS) extracted the data from the included studies using a standardized extraction form developed for this scoping review.
  • Studies were described according to their participant source and demographics, study design, primary aim and year published.
  • The principles of meta-ethnography were used to synthesise the data(36).
  • In the first stage, one author (JS) initially developed a framework of concepts and underlying themes, based on primary data in the studies and any pertinent points raised by the authors in the discussion.
  • In the second stage, two senior rheumatologists (FC, AW) with over 15 years of consultant experience independently reviewed the framework of concepts and themes to ensure clinical meaningfulness and face validity.

Quality assessment

  • Two reviewers (JS, KC) independently assessed all studies for the likelihood of bias and methodological quality.
  • Qualitative studies were assessed using the Critical Appraisal Skills Program appraisal tool(37).
  • Quantitative studies were assessed using a modified incidence/prevalence study tool designed to identify bias created by Hoy et al.(38) For quantitative studies, low risk of bias was defined as scoring 8 or more “yes” answers, moderate risk of bias was defined as 6 to 7 “yes” answers and high risk of bias was defined as 5 or fewer “yes” answers.

Overview of included studies

  • The search strategy returned 1405 papers of which 27 manuscripts met the inclusion criteria for this review.
  • The descriptive characteristics of the included studies are shown in Table 1.
  • Quantitative studies’ included between 101 and 5604 participants, with the mean age ranging between 55 and 68 years.
  • The percentage of female participants ranged between 60 and 86%.

Results of review

  • The themes identified in the search are summarized in Table 2. Patients’ perceived needs related to communication Nine studies focused on patients’ perceived needs related to communication and the relationship between patients with inflammatory arthritis and their healthcare practitioners.
  • In all of these studies, a holistic and positive consultation with healthcare providers was valued.
  • Attributes important in healthcare interactions included empathy, understanding attitudes and feeling listened to.(47, 49, 53, 57, 63) A good relationship with healthcare providers was important to many patients,(5, 43, 53) while a holistic approach was also often favoured.(50, 57, 63).

Need for clear communication

  • The importance of clear explanations and provision of information, particularly regarding their disease, investigation results and treatment options, was important to many participants.(47, 53) Many patients expressed frustration at perceived “mixed messages” regarding the provision of information from their healthcare practitioners.
  • Barriers to shared decision-making included the perception of doctors not taking their problems seriously, not being offered a role in decision making and sub-optimal understanding of the information surrounding particular decisions.
  • (5, 47, 50, 53, 55) Patients’ need to gain information by sharing experiences with other patients (47, 50) Accessing electronic health records A study by Van der Vaart(52) explored the benefits of patients accessing their own electronic medical records, with some perceived benefits including feeling involved and improving the quality of their care.
  • Patients’ perceived needs related to various aspects of follow-up care Patient-perceived needs related to the operational aspects of care in clinics were explored in nine studies, particularly the type of follow-up care, access to healthcare professionals and length of time allocated for consultations.

Length of consultation

  • Arthur 2004 Length of consultation was an important factor to many participants, particularly in secondary care Lempp 2006.
  • Many patients highlighted the importance of having the choice of supports needed and access to these in times of need Timely care, accessible review, specialist referral and in times of need Lempp 2006.
  • Many patients expressed the desire to have reduced waiting times for practitioners and investigations.
  • Many patients also valued efficient clinic staff and encounters with clinics.

External factors

  • Insurance coverage was associated with greater number of physician visits for psoriasis and psoriatic arthritis.
  • Prohibitive cost was a common reason for not seeking specialist care (21%).
  • Many patients were encouraged by their family members to seek care for their RA Fraenkel 2014 Role responsibility was seen as an important factor when considering risks and benefits of potential treatments for many patients Jong 2012.
  • One third of participants reported barriers to CAM use.
  • Many participants had family members only suggest complementary therapies for their symptoms.

Need for allied health and CAM

  • There were seven studies that investigated CAM use in patients with inflammatory arthritis,(41, 44, 45, 51, 58-60) which primarily explored the different types, frequency and reasons for using CAM.
  • There were two studies that investigated use of allied health services.(54, 64) Utilization and perceived need for allied health services Feldman(64) found a low referral rate to physiotherapy and occupational therapy in chronic arthritis, although most patients who felt they required these services received them (96%).
  • Neiderman(54) found the use of joint protection strategies was perceived by patients to improve pain, function and psychological wellbeing, but barriers to implementation were mainly the time and effort required, as well as potential embarrassment when using these strategies.
  • Perceived need for different modalities of care.
  • The most commonly reported reasons for using CAM were symptom relief where conventional treatments were perceived to have failed,(44, 45, 51, 58, 60) and to complement conventional therapies in disease management.

DISCUSSION

  • This review identified 27 studies(5, 39-64) that explored the patients’ perspective relating to non-pharmacologic health service needs for inflammatory arthritis.
  • While not a primary, patient-centred study, their review provides important secondary evidence of factors, reported by patients, which are perceived to be important in the management of their inflammatory arthritis in the context of health services.
  • Finally, the authors acknowledge that the concept of patients’ needs is multidimensional and complex.
  • Such potential variability may result in not identifying some evidence where the definition of ‘need’ differed substantially to the one applied in this review.

Authorship contributions

  • AW, FC, MS & KS made substantial contributions towards the conception, design and acquisition of data for this study.
  • JS and KC made significant contributions towards acquisition of data and analysis.
  • All authors were involved in drafting the manuscript and revising it for critically important conceptual material.
  • All authors have given approval for the final version of this review for publication.

Author and year Results Communication

  • Could more easily participate in decision making when they are invited to do so, when they are taken seriously and being listened to and when the doctor is open to answering questions.
  • Barriers to shared decision-making included perception of doctors not taking patients’ problems seriously, not being offered a role in decision making and sub-optimal understanding of the information surrounding the particular decision.
  • Most patients felt it was important to be able to lead discussions with their practitioners (72%) Sharing experiences with other patients Lempp 2006.
  • Some patients expressed a desire to have other RA patients as either volunteers or workers in their clinics Radford 2008 Participants felt having other RA patients to talk to would be helpful for emotional support.

Disease factors

  • Greater disease severity was associated with greater number of physician and specialist visits Flurey 2013.
  • Flare symptoms often prompted many patients to seek care for their disease Fraenkel 2014 Patients who were either very strongly impacted or minimally impacted by their disease were not open to alternative treatment options.
  • Patients who were moderately impacted by their disease were more open to treatment alternatives.

Patient factors

  • Berkanovic 1995 Patients with negative attitudes to previous care were less likely to self-initiate follow-up Bhutani 2013.
  • For some patients, the effort of the consultation process was a barrier to seeking specialist care for their psoriasis and psoriatic arthritis (11%).
  • Many patients also avoided follow-up for their disease as they had “given up” on it (27.6%).
  • Some patients avoided seeking specialist foot care for their RA due to beliefs that this may negatively influence treatment decisions regarding their RA Flurey 2013 Seeking medical care was often considered by participants as a last resort for symptoms Fraenkel 2014.
  • Age was seen by many participants as an important factor in considering treatment options Kumar 2010 Many patients misattributed symptoms when delaying initial presentation for RA, while some either ignored symptoms or hoped they would go away with time or self-administered treatments Oliver 2008 Delays for RA diagnosis and specialist referral included misattribution of symptoms by patients.

Modalities used and prevalence of use

  • Buchbinder 2002 73% of patients had used some form of CAM and 32% had visited at least one complementary practitioner in the preceding year.
  • The most commonly used supplements were herbs, glucosamine/chondroitin, vitamins and minerals Jong 2012 76% of participants had used some form of CAM (i.e., Dietary supplements) or related therapies within the previous 2 years.
  • Perceived benefits from acupuncture included relief of pain and inflammation, improved mobility, reduction of medication use and improvement in fatigue Ikuyama 2009 Predictors of DS use were female sex, younger age and time from RA diagnosis Expected effects of DS among users included relief of RA symptoms, promotion of general health and replenishing nutrients.
  • All participants saw their use of CAM as an adjunct to conventional treatment rather than replacing it Relief of pain and symptoms was the most frequently mentioned reason for using CAM Cost was only seen as an issue for participants if the CAM treatments were not perceived as effective Rao 1999.

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TL;DR: This Cochrane Review provides the best evidence about occupational therapy that the authors have today that occupational therapy can help people with rheumatoid arthritis to do daily chores such as dressing, cooking and cleaning and with less pain.
Abstract: Main results Thirty-eight out of 58 identified occupational therapy studies fulfilled all inclusion criteria. Six controlled studies had a high methodological quality. Given the methodological constraints of uncontrolled studies, nine of these studies were judged to be of sufficient methodological quality. The results of the best evidence synthesis shows that there is strong evidence for the efficacy of “instruction on joint protection” (an absolute benefit of 17.5 to 22.5, relative benefit of 100%) and that limited evidence exists for comprehensive occupational therapy in improving functional ability (an absolute benefit of 8.7, relative benefit of 20%). Indicative findings for evidence that “provision of splints” decreases pain are found (absolute benefit of 1.0, relative benefit of 19%). Authors’ conclusions There is evidence that occupational therapy has a positive effect on functional ability in patients with rheumatoid arthritis. P L A I N L A N G U A G E S U M M A R Y Occupational therapy for rheumatoid arthritis Does occupational therapy help people with rheumatoid arthritis? To answer this question, scientists analysed 38 studies. The studies tested over 1700 people who had rheumatoid arthritis. People were either counseled, trained in skills or trained to move or do daily chores with less pain, taught to protect their joints, given splints, taught to use assistive devices, or had no therapy. Not all studies were high quality but this Cochrane Review provides the best evidence about occupational therapy that we have today. What is occupational therapy and how could it help rheumatoid arthritis? Rheumatoid arthritis is a disease in which the body’s immune system attacks its own healthy tissues. The attack happens mostly in the joints of the feet and hands and causes redness, pain, swelling and heat around the joint. People with rheumatoid arthritis can find it difficult to do daily chores such as dressing, cooking, cleaning and working. Occupational therapists can give advice on how to do every day activities with less pain or advice on how to use splints and assistive devices. How well does it work? A high quality study showed that people could do daily chores better after having occupational therapy with training, advice and counseling. Two high quality studies showed that people given advice about how to protect their joints could do daily chores better than people with no advice or another type of occupational therapy. But both therapies did not help overall well-being or pain. Another high quality study showed that people trained to move or do daily activities could move just as well as and with the same amount of pain as people who did not have occupational therapy. The strength of their grip was also improved immediately after wearing a splint. But hand movement was less after wearing a splint There was not enough information to say whether advice about using assistive devices is helpful. What is the bottom line? There is “gold” level evidence that occupational therapy can help people with rheumatoid arthritis to do daily chores such as dressing, cooking and cleaning and with less pain. Benefits are seen with occupational therapy that includes training, advice and counseling and also with advice on joint protection. Splints can decrease pain and improve the strength of one’s grip, but it may decrease hand movement. 2 Occupational therapy for rheumatoid arthritis (Review) Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. B A C K G R O U N D Rheumatoid arthritis (RA) patients show a reduction in physical capacities compared to healthy persons. Symptoms such as pain, fatigue, stiffness and decreased muscle strength cause difficulties with daily activities like grooming and dressing, cooking a meal, cleaning, shopping, workand leisure activities. The physical, personal, familial, social and vocational consequences of rheumatoid arthritis are extensive. Occupational therapy (OT) is concerned with facilitating people in performing their daily living activities, and in overcoming barriers by maintaining or improving abilities or to compensate for decreased ability in the performance of occupations (Lindquist 1999). The most important interventions in occupational therapy are training of skills, counseling, education of joint protection skills, prescription of assistive devices and the provision of splints (Melvin 1998). Advice/instruction in the use of assistive devices, training of self care activities and productivity activities are the three most often chosen interventions by occupational therapists for rheumatoid arthritis patients (Driessen 1997). Till now, the evidence on the effects of occupational therapy for patients with rheumatoid arthritis on functional performance and social participation has not been reviewed systematically. So far, one narrative review (Clarke 1999) discussed the effectiveness of splinting, joint protection, and provision of aids/equipment for several rheumatic diseases on basis of the results of only a few studies on occupational therapy. One Cochrane review (Egan 2003) addresses the efficacy of splints and orthosis for RA patients, evaluating only a small part of OT interventions. Therefore, we conducted a systematic review of published studies evaluating occupational therapy for rheumatoid arthritis O B J E C T I V E S To determine whether OT interventions for RA patients improve outcome on functional ability, social participation and/or health related quality of life.

34 citations

Journal ArticleDOI
TL;DR: SpAMS is a time- and cost-saving disease management tool that can help patients with AS perform self-management and provide valuable data to clinicians.
Abstract: Objectives. Ankylosing spondylitis (AS) is a chronic disease that decreases mobility, function, and quality of life. This study introduced the “Smart-phone SpondyloArthritis Management System” (SpAMS), an interactive mobile health (mHealth) tool designed for AS/spondyloarthritis (SpA) disease management and used SpAMS data to evaluate clinical characteristics of Chinese patients with AS. Methods. SpAMS integrates patient’s and physician’s portals in a smart phone application. The Chinese Ankylosing Spondylitis Prospective Imaging Cohort was launched using SpAMS in April 2016. Patient self-assessments were completed online at baseline and at every subsequent clinic visit. Physician-reported assessments and treatments were recorded by rheumatologists during each visit. Results. In total, 1201 patients with AS [mean (SD) age, 30.6 (8.7) years; male, 82.6%] were recruited. Mean (SD) disease duration was 8.4 (6.1) years. Past or current symptoms of acute anterior uveitis (AAU), psoriasis, and inflammatory bowel disease (IBD) were observed in 21.0%, 3.7%, and 9.4% of patients, respectively. AAU and IBD occurred significantly more in patients with symptom duration > 10 years. The most commonly used medications at baseline were nonsteroidal anti-inflammatory drugs (98.2%). Patients using tumour necrosis factor inhibitors accounted for 20.8%, and 66.4% of patients used conventional synthetic disease-modifying antirheumatic drugs. At baseline, 57.2% of patients had inactive disease (ID)/low disease activity (LDA); this rate significantly improved to 79.2% after a mean follow-up of 13.3 (5.9) months. Compared with relapsed patients, new achievers of ID/LDA underwent more online patient assessments (P < .001). Problems solved in SpAMS caused 29.1% of clinic visits to a tertiary hospital unnecessary. SpAMS saved an average of 5.3 hours and 327.4 RMB per person on traffic expenses; these expenses equalled 16% of the Chinese monthly disposable personal income. Conclusions. SpAMS is a time- and cost-saving disease management tool that can help patients with AS perform self-management and provide valuable data to clinicians.

19 citations

Journal ArticleDOI
01 Feb 2019-BMJ Open
TL;DR: There is a paucity of research that has explored or evaluated PCC for women in the conditions of interest, and more research is needed to fully conceptualise and describe PCCW across different characteristics and conditions, and to test interventions that improve PCCw.
Abstract: Purpose Efforts are needed to reduce gendered inequities and improve health and well-being for women. Patient-centred care (PCC), an approach that informs and engages patients in their own health, is positively associated with improved care delivery, experiences and outcomes. This study aimed to describe how PCC for women (PCCW) has been conceptualised in research. Methods We conducted a theoretical rapid review of PCCW in four health conditions. We searched MEDLINE, EMBASE, CINAHL, SCOPUS, Cochrane Library and Joanna Briggs index for English-language articles published from January 2008 to February 2018 inclusive that investigated PCC and involved at least 50% women aged 18 or older. We analysed findings using a six-domain PCC framework, and reported findings with summary statistics and narrative descriptions. Results After screening 2872 unique search results, we reviewed 51 full-text articles, and included 14 (five family planning, three preventive care, four depression, one cardiovascular disease and one rehabilitation). Studies varied in how they assessed PCC. None examined all six PCC framework domains; least evaluated domains were addressing emotions, managing uncertainty and enabling self-management. Seven studies that investigated PCC outcomes found a positive association with appropriate health service use, disease remission, health self-efficacy and satisfaction with care. Differing views about PCC between patients and physicians, physician PCC attitudes and geographic affluence influenced PCC. No studies evaluated the influence of patient characteristics or tested interventions to support PCCW. Conclusion There is a paucity of research that has explored or evaluated PCCW in the conditions of interest. We excluded many studies because they arbitrarily labelled many topics as PCC, or simply concluded that PCC was needed. More research is needed to fully conceptualise and describe PCCW across different characteristics and conditions, and to test interventions that improve PCCW. Policies and incentives may also be needed to stimulate greater awareness and delivery of PCCW.

17 citations

Journal ArticleDOI
TL;DR: To systematically review evidence of the impact of inflammatory arthritis on, or association ofinflammatory arthritis with, intimate relationships and sexual function, a large number of patients with inflammatory arthritis have had unprotected sex.
Abstract: Objective To systematically review evidence of the impact of inflammatory arthritis on, or association of inflammatory arthritis with, intimate relationships and sexual function. Methods Ovid Medline, Ovid PsycINFO, Ovid Embase, and EBSCO CINAHL databases were searched. Two independent reviewers selected articles, extracted data, and conducted manual searches of reference lists from included studies and previous reviews. The quality of evidence was assessed using standard risk-of-bias tools. Results Fifty-five eligible studies were reviewed. Of these, 49 (89%) were quantitative, 5 (9.1%) were qualitative, and 1 (1.8%) used a mixed-method design. Few quantitative studies were rated as low risk of bias (n = 7 [14%]), many were rated as moderate (n = 37 [74%]) or high risk (n = 6 [12%]). Quantitative study sample sizes ranged from 10 to 1,272 participants, with a reported age range 32-63 years. Qualitative study sample sizes ranged from 8 to 57 participants, with a reported age range 20-69 years. In studies reporting the Female Sexual Function Index, all inflammatory arthritis groups demonstrated mean scores ≤26.55 (range of mean ± SD scores: 14.2 ± 7.8 to 25.7 ± 4.7), indicating sexual dysfunction. In studies reporting the International Index of Erectile Function, all inflammatory arthritis groups reported mean scores ≤25 (range of mean ± SD scores: 16.0 ± 5.3 to 23.8 ± 7.0), indicating erectile dysfunction. Key qualitative themes were impaired sexual function and compromised intimate relationships; prominent subthemes included inflammatory arthritis-related pain and fatigue, erectile dysfunction, diminished sexual desire, and sexual function fluctuations according to disease activity. Conclusion Sexual dysfunction appears highly prevalent among men and women with inflammatory arthritis, and increased clinician awareness of this impairment may guide provision of tailored education and support.

17 citations

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TL;DR: This review indicates there may be differential benefits to combined formulations of Bifidobacteriales and Lactobacillales compared to purely Lactsobacllales formulations, with respect to reducing pain, lowering CRP and improving quality of life.

13 citations

References
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TL;DR: A framework for conducting a scoping study is outlined based on recent experiences of reviewing the literature on services for carers for people with mental health problems and it is suggested that a wider debate is called for about the role of the scoped study in relation to other types of literature reviews.
Abstract: This paper focuses on scoping studies, an approach to reviewing the literature which to date has received little attention in the research methods literature. We distinguish between different types of scoping studies and indicate where these stand in relation to full systematic reviews. We outline a framework for conducting a scoping study based on our recent experiences of reviewing the literature on services for carers for people with mental health problems. Where appropriate, our approach to scoping the field is contrasted with the procedures followed in systematic reviews. We emphasize how including a consultation exercise in this sort of study may enhance the results, making them more useful to policy makers, practitioners and service users. Finally, we consider the advantages and limitations of the approach and suggest that a wider debate is called for about the role of the scoping study in relation to other types of literature reviews.

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"Patient-perceived health service ne..." refers methods in this paper

  • ...As such, we adopted a scoping review approach to conduct the review, as described by Arksey and O’Malley,(32), underpinned by systematic review principles for evidence identification and analysis....

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TL;DR: Specific recommendations to clarify and enhance this methodology are outlined for each stage of the Arksey and O'Malley framework, to support the advancement, application and relevance of scoping studies in health research.
Abstract: Scoping studies are an increasingly popular approach to reviewing health research evidence. In 2005, Arksey and O'Malley published the first methodological framework for conducting scoping studies. While this framework provides an excellent foundation for scoping study methodology, further clarifying and enhancing this framework will help support the consistency with which authors undertake and report scoping studies and may encourage researchers and clinicians to engage in this process. We build upon our experiences conducting three scoping studies using the Arksey and O'Malley methodology to propose recommendations that clarify and enhance each stage of the framework. Recommendations include: clarifying and linking the purpose and research question (stage one); balancing feasibility with breadth and comprehensiveness of the scoping process (stage two); using an iterative team approach to selecting studies (stage three) and extracting data (stage four); incorporating a numerical summary and qualitative thematic analysis, reporting results, and considering the implications of study findings to policy, practice, or research (stage five); and incorporating consultation with stakeholders as a required knowledge translation component of scoping study methodology (stage six). Lastly, we propose additional considerations for scoping study methodology in order to support the advancement, application and relevance of scoping studies in health research. Specific recommendations to clarify and enhance this methodology are outlined for each stage of the Arksey and O'Malley framework. Continued debate and development about scoping study methodology will help to maximize the usefulness and rigor of scoping study findings within healthcare research and practice.

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"Patient-perceived health service ne..." refers methods in this paper

  • ...This approach was performed to capture the breadth of the topic to enable a comprehensive exploration of the patients’ perspective, map the existing literature and to identify gaps in the evidence.(33, 34) This review formed part of a larger project examining patients’ perceived needs relating to musculoskeletal health more generally (35)....

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TL;DR: The frequency of use of unconventional therapy in the United States is far higher than previously reported and expenditure associated with use in 1990 amounted to approximately $13.7 billion, comparable to the $12.8 billion spent out of pocket annually for all hospitalizations in theUnited States.
Abstract: Background Many people use unconventional therapies for health problems, but the extent of this use and the costs are not known. We conducted a national survey to determine the prevalence, costs, and patterns of use of unconventional therapies, such as acupuncture and chiropractic. Methods We limited the therapies studied to 16 commonly used interventions neither taught widely in U.S. medical schools nor generally available in U.S. hospitals. We completed telephone interviews with 1539 adults (response rate, 67 percent) in a national sample of adults 18 years of age or older in 1990. We asked respondents to report any serious or bothersome medical conditions and details of their use of conventional medical services; we then inquired about their use of unconventional therapy. Results One in three respondents (34 percent) reported using at least one unconventional therapy in the past year, and a third of these saw providers for unconventional therapy. The latter group had made an average of 19 visits to suc...

4,223 citations

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TL;DR: Results provide strong support for the view that differentiation does exist among the five areas and that the measures do relate to the phenomena with which they are identified.
Abstract: Access is an important concept in health policy and health services research, yet it is one which has not been defined or employed precisely. To some authors "access" refers to entry into or use of the health care system, while to others it characterizes factors influencing entry or use. The purpose of this article is to propose a taxonomic definition of "access." Access is presented here as a general concept that summarizes a set of more specific dimensions describing the fit between the patient and the health care system. The specific dimensions are availability, accessibility, accommodation, affordability and acceptability. Using interview data on patient satisfaction, the discriminant validity of these dimensions is investigated. Results provide strong support for the view that differentiation does exist among the five areas and that the measures do relate to the phenomena with which they are identified.

2,587 citations

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TL;DR: Positive perceptions of patient-centered communication were associated with better recovery from their discomfort and concern, better emotional health 2 months later, and fewer diagnostic tests and referrals.
Abstract: Background: We designed this observational cohort study to assess the association between patient-centered communication in primary care visits and subsequent health and medical care utilization. Methods: We selected 39 family physicians at random, and 315 of their patients participated. Office visits were audiotaped and scored for patient-centered communication. In addition, patients were asked for their perceptions of the patient-centeredness of the visit. The outcomes were: (1) patients' health, assessed by a visual analogue scale on symptom discomfort and concern; (2) self-report of health, using the Medical Outcomes Study Short Form-36; and (3) medical care utilization variables of diagnostic tests, referrals, and visits to the family physician, assessed by chart review. The 2 measures of patient-centeredness were correlated with the outcomes of visits, adjusting for the clustering of patients by physician and controlling for confounding variables. Results: Patient-centered communication was correlated with the patients' perceptions of finding common ground. In addition, positive perceptions (both the total score and the subscore on finding common ground) were associated with better recovery from their discomfort and concern, better emotional health 2 months later, and fewer diagnostic tests and referrals. Conclusions: Patient-centered communication influences patients' health through perceptions that their visit was patient centered, and especially through perceptions that common ground was achieved with the physician. Patient-centered practice improved health status and increased the efficiency of care by reducing diagnostic tests and referrals.

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"Patient-perceived health service ne..." refers background in this paper

  • ...(18-27) A key question is why should these patient-centred components of care and outcomes be any different in the context of inflammatory arthritis? Relative to the vast majority of chronic health conditions that are more prevalent with ageing, inflammatory arthritis typically affects younger people, most often when their careers, relationships and families are commencing....

    [...]

Frequently Asked Questions (2)
Q1. What are the contributions in "Patient-perceived health service needs in inflammatory arthritis: a systematic scoping review" ?

Descriptive data regarding study design and methodology were extracted and risk of bias assessed. The reporting of CAM use to doctors was variable, with several factors contributing to under-reporting. 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. 

Future research examining the role and efficacy of CAM are also warranted, particularly given their high level of use and patient interest, as well as their potential to interact with medical therapies. Further work will be needed to directly determine whether there are specific patient priorities for the management of inflammatory arthritis and the adequacy of their health systems to meet these needs. Such potential variability may result in not identifying some evidence where the definition of ‘ need ’ differed substantially to the one applied in this review. The extent of CAM use in the literature suggests that patient relevant outcomes are not being met by current management strategies.