Turner JP, Richard C, Lussier MT, Lavoie ME, Farrell B, Roberge D, and Tannenbaum C
Therapeutic Advances In Drug Safety [Ther Adv Drug Saf] 2018 Oct 20; Vol. 9 (12), pp. 687-698. Date of Electronic Publication: 20181020 (Print Publication: 2018).
Background: Little is known about the initiation, style and content of patient and healthcare provider communication around deprescribing. We report the findings from a content analysis of audio-recorded discussions of proton pump inhibitor (PPI) and benzodiazepine deprescribing in primary care. Methods: Participants were healthcare providers (n = 13) from primary care practices (n = 3) and patients aged ⩾65 (n = 24) who were chronic users of PPIs or benzodiazepines. The EMPOWER educational brochures were distributed prior to (n = 15) or after (n = 9) the patient's usual healthcare provider appointment. Conversations were audio-recorded and coded using MEDICODE to analyze who initiated different themes, whether they followed a monologue or dialogue style, and to what extent the thematic content addressed issues pertaining to: 'dosage/instructions,' 'medication action and efficacy,' 'risk/adverse effects,' 'attitudes/emotions,' 'adherence' and 'follow up.' Descriptive analysis of the conversations was performed with comparison between patients who received the EMPOWER brochure before or after their appointments. Results: Patients were mostly women (67%) with a mean age of 74 ± 6 years. For PPI users, prior education resulted in a greater proportion of themes initiated by patients (44% versus 17%) and maintaining dialogue-style conversations (48% versus 28%). Among benzodiazepine users, conversation initiation (52% versus 47%) and conversation style was similar between both groups. The content of deprescribing conversations for PPIs revealed that patients and their healthcare providers focused less on 'dosage/instructions,' and more on the 'medication action and efficacy' and the necessity for 'follow up.' Conversations about stopping benzodiazepines were more likely to stagnate on the 'if' rather than the 'how.' Conclusion: The initiation, style and content of the conversations varied between PPI and benzodiazepine users, suggesting that healthcare providers will need to tailor deprescribing conversations accordingly.
Games--Peru--History and Incas--Social life and customs
Ce livre, premier ouvrage entièrement consacré aux jeux andins, constitue un apport de grande valeur sur le Pérou préhispanique. Inventions sociales, les jeux y remplissaient un rôle déterminant dans le processus de prise de décision pour un partage et une redistribution équitable des biens, tâches et responsabilités tant au niveau individuel que collectif. Leur étude minutieuse aboutit à une meilleure compréhension des institutions et de l'organisation administrative de l'empire inca.
MEDICAL communication, CHRONIC diseases, INTERACTION analysis in education, PATIENT participation, INTERPERSONAL communication, PRIMARY health care, CHRONIC disease treatment, COMMUNICATION, COMPARATIVE studies, GOAL (Psychology), LONGITUDINAL method, RESEARCH methodology, MEDICAL cooperation, MEDICAL protocols, HEALTH outcome assessment, PATIENT compliance, PATIENT education, PHYSICIAN-patient relations, QUESTIONNAIRES, RESEARCH, EVALUATION research, RANDOMIZED controlled trials, PATIENT selection, PATIENT-centered care, and PSYCHOLOGY
Objective: To evaluate the efficacy of two web-based educational approaches on doctor-patient communication. The study focused on chronic disease (CD) patients in a lengthy relationship with their family physician (FP) who had not reached guideline suggested treatment goals (off-target) for their CDs.Methods: 322 hypertensive, diabetic, or dyslipidemic patients of 18 FPs were randomised into three groups: Usual Care (UC), e-Learning (e-L) and e-Learning+Workshop (e-L+W). Interventions were based on Cegala's PACE system: Prepare, Ask questions, Check understanding, Express concerns. Communication was evaluated using the Roter Interaction Analysis System (RIAS), MEDICODE and questionnaires.Results: Encounter length was similar across groups. RIAS showed that e-L+W group engaged in more socio-emotional talk and PACE-like utterances. MEDICODE showed that interventions increased frequency, initiative and dialogue for selected CD medication themes. Quality of communication was perceived as satisfactory at baseline and did not change.Conclusion: Following interventions, CD patients were more activated even in well-established doctor-patient relationships.Practice Implications: PACE web-based interventions are accessible and effective at increasing CD patients' participation. They increase legitimacy to express the patient experience. FPs should present this type of training to CD patients as an integral part of their routine practice and consider referring patients to complete it. [ABSTRACT FROM AUTHOR]
Latter S, Sibley A, Skinner TC, Cradock S, Zinken KM, Lussier MT, Richard C, and Roberge D
International Journal Of Nursing Studies [Int J Nurs Stud] 2010 Sep; Vol. 47 (9), pp. 1126-38. Date of Electronic Publication: 2010 Mar 07.
England, Humans, Diabetes Mellitus drug therapy, Drug Prescriptions, Hypoglycemic Agents therapeutic use, Nurses, and Patient Compliance
Background: Nurse prescribers are in a key position to promote medicine-taking in diabetes. Although patients' beliefs about medicines are important predictors of medicine-taking, evidence suggests nurses do not routinely explore these. Objectives: To evaluate a theory-based intervention designed to increase nurse prescribers' exploration of medicines' beliefs with people with diabetes. Design: Mixed methods concurrent triangulation design. Settings: Nurse prescribers were recruited from 7 Trusts in England. Participants: A purposive sample of 14 nurse prescribers attended four 1 day workshops. Methods: Audio-recordings of each nurse prescribers' consultations with diabetes patients were collected at baseline, 1 week, 3 months and 6 months after the intervention. Nurse prescribers were interviewed at 1 month and 6 months post-intervention. Changes in medicines' discussion and participation in consultations were analysed using MEDICODE. Interview data were analysed using Framework Analysis. Results: MEDICODE themes of 'attitudes towards medication' showed a significant rise at 1 week (p<0.01) and 3 months (p<0.05). 'Asks patient opinion about medication' significantly increased at 1 week (p<0.01). Discussion on 'concerns about medication' rose significantly at 1 week (p<0.001) and 6 months (p<0.01). Discussion on 'expected effects of medication', 'action of medication' and 'reasons for medication' showed no change. There were no significant changes in Dialogue Ratio. However, the Preponderance of Initiative moved towards more patient initiative at 1 week (p<0.0001), 3 months (p<0.0001), and 6 months (p<0.0001). In interviews, nurses reported increased attention to patients' medication beliefs and adoption of patient-centred skills. Contextual factors that positively influenced ability to explore medicines beliefs in practice settings were: support of colleagues and practicing new skills. Inhibiting factors included: patients' perceived lack of receptivity, time constraints, and concerns about opening a 'can of worms'. Six months interviews revealed using skills in practice enhanced nurses' confidence and sustainability of skills requires a nurse-patient relationship. Method triangulation illuminated how the intervention was implemented in practice contexts. Conclusions: The intervention was effective at changing some key dimensions of prescribing consultations. The use of a self-efficacy framework in the intervention, to promote nurses' confidence in working in a different way, may have been instrumental in effecting the changes found. Contextual factors influencing beliefs exploration in medicine-taking consultations were identified. (Copyright (c) 2010 Elsevier Ltd. All rights reserved.)