Journal of evaluation in clinical practice最新文献

{"title":"Patient-Centered Care in Chronic Diseases Among Iranian Patients: The Acceptability of Paternalism as a Distinctive Feature","authors":"Mohsen Khosravi,&nbsp;Payam Shojaei,&nbsp;Zahra Kavosi,&nbsp;Ramin Ravangard,&nbsp;Ehsan Shamsi Gooshki,&nbsp;Milad Ahmadi Marzaleh,&nbsp;Sajad Delavari","doi":"10.1111/jep.70073","DOIUrl":"https://doi.org/10.1111/jep.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Research on patient-centeredness in managing chronic diseases like cancer, diabetes, stroke, and heart disorders is gaining prominence. This approach in chronic disease management involves various dimensions and elements, the importance of which has been presented to differ.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>The present research, carried out in the year 2023, aimed to identify and prioritize existing dimensions and elements of patient-centered care for chronic diseases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Firstly, multiple databases including the Cochrane Database of Systematic Reviews, Scopus, PubMed and ProQuest were searched. Secondly, 35 chronic patients were interviewed; Finally, a sample of 30 experts familiar with the context was asked to rank the dimensions and elements of patient-centered care using Best-Worst method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study identified 6 dimensions and 13 elements of patient-centered care in chronic diseases. The findings indicated that accessibility, quality, education, timeliness and affordability were the five elements that ranked highest in importance for designing and implementing patient-centered care interventions for chronic diseases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The results presented that Iranian patients with chronic diseases exhibit a positive attitude towards paternalistic behavior and often prefer others to make the best therapeutic decisions on their behalf. Our research revealed that the concept of patient-centered care differs across regions and cultures, highlighting the need for policymakers and researchers to adapt strategies to the specific characteristics of local populations around the globe.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applying Kotter's Change Model to Implement Constructive Alignment in Clinical Teaching Rounds for Service Evaluation","authors":"Rong Liu,&nbsp;Ying Wang,&nbsp;Ronghui Huang,&nbsp;Haina Xing,&nbsp;Meitao Wang,&nbsp;Xinjun Jiang,&nbsp;Xiaofei Wu","doi":"10.1111/jep.70076","DOIUrl":"https://doi.org/10.1111/jep.70076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Clinical nursing education is crucial for developing competent nursing professionals, and the evolution of teaching methodologies is essential for this development. There is a growing concern about the inadequacy of teaching capabilities among clinical instructors, leading to a significant disparity between students’ theoretical understanding and their practical application in real-world clinical settings. This is a study of the systematic application of Kotter's 8 steps to bring about major changes in the skills, behaviors and motivations of clinical faculty. It is also a study to identify specific patterns of teaching activity that are more to the practice of teaching rounds through the use of the constructive alignment framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>The study aims to develop and implement a clinical faculty development program using constructive alignment (CA) as a framework. Objectives include identifying weaknesses in teaching rounds, conducting a gap analysis based on preprogram self-efficacy surveys, and aligning teaching practices with learning outcomes to improve the effectiveness of clinical education. Kotter's change model has been effectively utilized to navigate and sustain transformation within faculty development initiatives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>The study used a mixed methods approach, integrating qualitative research through Participatory Action Research with quantitative data from self-efficacy surveys. A group of researchers conducted pre- and post-program self-efficacy surveys, teacher training and interviews over the course of a year. The project was structured into three phases—diagnostic, intervention and evaluation—and we mapped all phases onto Kotter's 8 steps to promoting change. We navigated clinical teachers to conduct teaching rounds under the constructive alignment framework, subsequently employing inductive thematic analysis to meticulously assess the effectiveness of our intervention strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low Back Pain Presentation and Management at the Emergency Department: Differences Between Older Adults Residing in the Community and Aged Care Homes","authors":"Rod Ellem,&nbsp;Quinn Burling,&nbsp;Michel W. Coppieters,&nbsp;James Todd,&nbsp;Rowan Pickering","doi":"10.1111/jep.70088","DOIUrl":"https://doi.org/10.1111/jep.70088","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>In healthcare systems without gatekeeper access to Emergency Departments (ED), the number of people presenting for low back pain (LBP) is increasing substantially. Low back pain presentations at the Emergency Department are rarely caused by serious underlying pathology, and management often deviates from practice guidelines. Older adults (≥ 65 years) constitute approximately 30% of all ED LBP presentations. Little is known about differences in presentation characteristics and ED management between older adults from aged care homes and those living in the community.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>This study aimed to identify differences in presentation and management between people presenting at the ED for LBP from aged care homes versus those residing in the community.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective observational study of routinely collected healthcare data and chart audits of older adults from aged care homes (<i>N</i> = 64) and age and sex-matched community-dwelling older adults (<i>N</i> = 64) presenting to ED for LBP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients from aged care homes presented with more comorbidities (4 vs. 2), analgesic medication (84% vs. 70%) and polypharmacy (86% vs. 41%) and were more commonly admitted for ongoing analgesia or further diagnostic tests. Community-dwelling older adults were more frequently admitted for Allied Health input. ED administration of opiates was high for both groups (81% aged care; 91% community-dwelling). High rates of lumbar spine medical imaging (61% aged care; 50% community-dwelling) resulted in few acute radiographic findings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Older patients presenting to ED for LBP receive similar management regardless of their residential status. Hospital management of both groups does not align with current published recommendations namely in respect to imaging and pain medication.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70088","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Length of Stay and Its Affecting Factors in a General Hospital of a Multiple Nationality City in Western China","authors":"Li Fang,&nbsp;Wei Yi Yang,&nbsp;Hui Ling Liu,&nbsp;Zi Yang Fang,&nbsp;Qian Li Tang,&nbsp;Jin Hua Wang,&nbsp;Ren Rong Gong","doi":"10.1111/jep.70084","DOIUrl":"https://doi.org/10.1111/jep.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Length of stay (LOS) serves as a key metric for assessing hospital efficiency. However, LOS is complex and multidimensional, and influenced by various factors that require further explorations. The purpose of the present study was to examine factors and their interactions affecting LOS in a general hospital in western China.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study involved 9631 cases admitted to a tertiary general hospital in Guangxi province, China, from December 2018 to October 2020. LOS and 17 additional variables were collected from the Hospital Information System and integratively analyzed. As a novel factor created in the current study, agreement between admission and discharge departments was evaluated by comparing the admission department with the discharge department. Kruskal–Wallis and Mann–Whitney U tests were used to analyze the relationship of LOS with other variables. Multiple linear regression was employed to identify predictors of LOS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Variations in LOS were noted among patients based on gender, occupation, patient sources, contact persons, admission types, discharge types, disease severity types or medical payment methods, or patients with or without agreement between admission and discharge departments, the presence of hospital acquired infections (HAI) or antibiotic usages. No significant differences were found related to nationalities, marital statuses, patients with or without agreement between outpatient and discharge diagnoses, or agreement between admission and discharge diagnoses. Moreover, the number of hospitalizations, admission type, discharge type, disease severity type, agreement between admission and discharge departments, HAI, antibiotic usage, and medical payment method significantly predicted LOS, while others did not. The direct effects of agreement between admission and discharge departments on LOS were 86.88% of the total effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Factors affecting LOS were observed in the hospital, including agreement between admission and discharge departments. Recommendations should focus on resource allocation and optimization in decision-making to direct patients to suitable departments while improving other critical factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Signal Detection at SFDA: A Comprehensive Analysis of Current Practices and Future Directions","authors":"Mohammed I. Fouda,&nbsp;Abdulaziz Alakeel,&nbsp;Roaa M. Alamri,&nbsp;Mobarak S. Al Shahrani,&nbsp;Ali Y. Al Shahrani","doi":"10.1111/jep.70062","DOIUrl":"https://doi.org/10.1111/jep.70062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Saudi Food and Drug Authority (SFDA) plays a pivotal role in safeguarding public health through robust pharmacovigilance. Since establishing its signal detection section in 2015, SFDA has implemented a comprehensive framework to monitor and evaluate drug safety through proactive data collection, advanced analytical methods, and international collaborations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To provide a comprehensive analysis of the current practices in signal detection at SFDA, assess the effectiveness of its regulatory framework, in-house priority system, active surveillance programme, and global collaborations, and to offer recommendations for future enhancements in pharmacovigilance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A scientific review was conducted using publicly available literature, official SFDA guidelines, and internal reports. The evaluation focused on the regulatory mandate, data collection methodologies, signal generation processes (including weekly scanning of diverse sources), case validation, and the integration of advanced statistical techniques. Special emphasis was given to the in-house priority algorithm, active surveillance initiatives, and collaborative efforts with international bodies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The review highlights that SFDA's robust regulatory framework and innovative in-house priority algorithm have enhanced the efficiency of signal detection. The active surveillance programme has significantly increased the capacity for real-time monitoring, while global collaborations have facilitated knowledge exchange and harmonised methodologies. However, challenges persist regarding data quality, resource allocation, and the need for continuous training and improved communication among stakeholders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>SFDA's signal detection system effectively contributes to drug safety in Saudi Arabia by combining rigorous regulatory practices with innovative analytical methods and international cooperation. Addressing current challenges through advanced technologies, enhanced resource allocation, and strengthened stakeholder communication is recommended to further improve pharmacovigilance practices and ensure public health protection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Paradigmatic Shift: Telehealth Counselling's Expansion and Challenges in India","authors":"Anganabha Baruah","doi":"10.1111/jep.70089","DOIUrl":"https://doi.org/10.1111/jep.70089","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study provides a comprehensive analysis of the rapid expansion and transformative impact of telehealth counselling in India, a trend significantly propelled by the challenges posed by the COVID-19 pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>This paper presents a perspective on the current telehealth landscape, synthesizing insights from an extensive literature review. The investigation integrates qualitative insights from health care practitioners and clients, allowing for a multifaceted understanding of the emerging obstacles linked to telehealth implementation. The synthesis is structured around several key concepts identified in the literature, including the efficacy of telehealth counselling services compared to traditional face-to-face interactions, the resilience of mental health services during crises, and the growing acceptance of digital modalities among patients. Additionally, it explores significant challenges such as disparities in technological access, the need for comprehensive regulatory frameworks, varying levels of patient receptivity, infrastructural limitations, and the readiness of health care professionals to adopt telehealth technologies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>By focusing on these areas, the paper elucidates the complex interplay of technical, regulatory, and cultural factors shaping the telehealth ecosystem in India. It advocates for urgent policy enhancements and the continuous integration of technology to effectively address these barriers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>This perspective underscores the potential for telehealth counselling to evolve into a permanent and essential component of India's mental health service delivery model, ultimately contributing to a more resilient and accessible health care system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The conclusions drawn emphasize the necessity for targeted policy interventions and the establishment of robust technological infrastructures to foster a more inclusive and effective telehealth environment, ensuring mental health services reach all segments of the population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143818656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reasons for Downgrading the Certainty of Evidence for Indirectness in Synthesis of Surgical Procedures for Patients With Fractures: A Meta-Research Analysis","authors":"Julia Pozzetti Daou,&nbsp;Rachel Riera,&nbsp;Rafael Leite Pacheco","doi":"10.1111/jep.70091","DOIUrl":"https://doi.org/10.1111/jep.70091","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Indirectness occurs when the synthesized evidence may not be directly applied to the relevant clinical context. A common argument used by surgeons is that evidence that arises from clinical trials is limited due to a lack of fidelity regarding surgery techniques, materials, and surgeon and center experience. Considering that there are many particularities in surgical interventions for the treatment of bone fractures, diverseness is expected among trials that randomized patients to compare surgical procedures. An in-depth analysis of how this expected diverseness is reflected in indirectness judgments on the certainty of synthesized evidence is lacking.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>To analyze the certainty of evidence from all Cochrane reviews of surgical interventions for the treatment of patients with bone fractures and the reasons for indirectness downgrading.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A meta-research analysis of all Cochrane systematic reviews that compare any surgical interventions in patients with any type of bone fracture. A sensitive search was conducted in the Cochrane Database of Systematic Review from inception to 16 October 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The certainty of the evidence of all Cochrane reviews of surgical interventions for patients with fractures is very low or low in 66.5% of eligible outcomes. Indirectness contributed to the certainty downgrade in only 12.26% of outcomes (26/212), and of those, the indirectness was related to the intervention in 11.5% (4/26). The results show that although the certainty of evidence of surgical interventions for patients with fractures is usually downgraded, indirectness is not a common cause of concern.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The certainty of evidence for surgical interventions in patients with fractures is typically downgraded, often to very low. However, indirectness is not a common reason for such downgrading. The anticipated diverseness regarding surgery techniques, materials, and surgeon and center experience was not impactful in the overall certainty of evidence in the Cochrane reviews that were included.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70091","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143786693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Causes of Burn Injury in Children for Preschool","authors":"Mohammad Qtait","doi":"10.1111/jep.70054","DOIUrl":"https://doi.org/10.1111/jep.70054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Burn injuries are prevalent worldwide, especially in developing countries; and there are significant children burn injuries in Palestine. This study was performed to analyse the pattern, cause, of burn injuries in Palestine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Prospective study, we undertook a prospective study of all patients under 6 years who admitted to burn unit 1 January 2022, and 31 December 2022. In-person interviews with the children's parents determined the burns' genesis and environmental causes. Demographic and clinical data were obtained.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Result</h3>\u0000 \u0000 <p>The population being studied had a mean age of 3.1 years. The majority of the 91 patients who were burned did so because of scalds. Flame 10 sufferers represented 60% of the patients; 60% were residents of urban areas. Five people were living in residence. Most of the children (81 of the total) were with another person at the time of the burn injury, and the kitchen was the location of the burn in 41 cases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The patients' crowded environment was a challenge. Even when an adult was close, the caretaker did not watch the child well. Burns are likely in the kitchen, where people cook and eat harmful foods. First, ensure the kitchen is safe, and then apply other safety procedures around the house to decrease the danger of burns to children.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143786703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Prevalence and Predictors of Persistently High Primary Care Use Among National Health Insurance Patients in a Nigerian Medical Facility","authors":"Godpower Chinedu Michael,&nbsp;Zainab Abdulazeez Umar,&nbsp;Bukar Alhaji Grema","doi":"10.1111/jep.70081","DOIUrl":"https://doi.org/10.1111/jep.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>A small group of healthcare users make frequent hospital visits (≥ 10 annually) and consume a disproportionate amount of healthcare resources. Their characteristics among insured patients in developing countries like Nigeria are poorly understood.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the prevalence and predictors of persistently high primary care (PHPC) use (≥ 10 visits in two consecutive years) among National Health Insurance Authority (NHIA) enrollees.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cross-sectional study analyzed data from 380 randomly selected patients at the NHIA Clinic of a Nigerian tertiary hospital in 2022. Using a standardized proforma, their 2018 and 2019 data were collected, including biodata, clinic visit characteristics, diagnoses, and costs of medicines and investigations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The sample population was predominantly females (62.6%) with a mean age of 37.5 years. In 2018/2019, 75% (285/380) of patients visited for infectious diseases and 37.6% (143/380) for cardiovascular diseases (CVD). Only 2.6% (10/380) were PHPC users. The median cost of care was higher among PHPC users than the remaining users in 2018 (₦30,549.00 [US$84.60] vs. ₦10,290.00 [US$28.50]; Mann Whitney test [MWT] = 16.73, <i>p</i> &lt; 0.001) and in 2019 (₦41,238.50[US$114.20] vs. ₦9,523.50 [US$26.40]; MWT = 18.81, <i>p</i> &lt; 0.001). Older age, tribe, and having CVD were significantly associated with PHPC use, with CVD being a strong predictor (OR = 11.38, <i>p</i> = 0.037).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The prevalence of PHPC users was low, yet they consumed 3 to 4 times more resources in medicines and investigations than the other remaining patients. Patients with CVDs could form targets for interventions to reduce unnecessary visits and lower cost of care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143786705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General Practitioners' Perceptions of Patient Involvement—An Interview Study","authors":"Birgitte Nørgaard,&nbsp;Elisa Simonsen,&nbsp;Nanna Aarup Skotte,&nbsp;Michael Marcussen","doi":"10.1111/jep.70077","DOIUrl":"https://doi.org/10.1111/jep.70077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale and Aim</h3>\u0000 \u0000 <p>General practitioners (GPs) play an increasingly important role in the healthcare system, wherein patient involvement is a key element in delivering individualized and tailored treatment. This study aimed to explore GPs' perceptions of user involvement and their considered challenges and opportunities regarding user involvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A qualitative study with semi-structured interviews was conducted. The approach was inductive and open, and data were analysed thematically. Twelve GPs were recruited through snowball sampling and individually interviewed in March–April 2021.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Six themes were generated: Relation and knowledge; Negotiation; Compliance; Information, communication and dialog; Time and process; and GPs' considerations of involvement. The GPs described a plethora of tools and strategies to shape their relationship with the patient, individually inform the patient, and negotiate their power to achieve compliance and, thus, the best treatment for the patient.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>GPs consider patient involvement equal to information as a means to compliance to some extent, but they also consider information and compliance interdependent. However, patient involvement is challenging for the GPs when the patient is misinformed or when the GP's current status is poor.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 3","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jep.70077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143786704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}