Journal of evaluation in clinical practice
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The Drug Burden Index (DBI) measures exposure to anticholinergic and sedative drugs, which are associated with harm in older adults. To facilitate deprescribing in older Australian inpatients, we piloted an intervention bundle integrating the DBI in Electronic Medical Records, clinician deprescribing guides, consumer information leaflets and a stewardship pharmacist. ⋯ The intervention was well accepted by hospital clinicians. The bundle requires further integration into workflows for sustainability and assessment of generalisability in other health services. Given patients, carers and GPs reported poor medication-related communication, future interventions may target this.
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The patient's perception of physician empathy has a positive influence on patient behavior and treatment effects. The scale of Consultation and Relational Empathy (CARE) scale has been widely used to measure patients' perceptions of doctor empathy. However, the CARE scale lacks a standardized Mandarin version. In this study, we developed a Mandarin version of the CARE scale and validated its quality. ⋯ The scale could serve as an evaluation tool for patients' perceptions of doctors' empathy in primary-level medical service settings in Chinese mainland.
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Chronic pelvic pain syndrome (CPPS) is prevalent and a complex multifactorial condition. The incidence is rising. CPPS patients may benefit from multidisciplinary care in a structured care pathway. ⋯ Stakeholder focus groups using the nominal group technique was a pivotal step in the development of our CPPS care pathway. This step led to fundamental recommendations, of which a personalised treatment plan at an earlier stage in the patient journey might be the most impactful. This is now implemented, and we monitor the effects on outcomes, quality of life and patient's satisfaction.
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The Patient-Centred Medical Home (PCMH) is a model of team-based care that is patient centred, coordinated, accessible, and focused on quality and safety. To learn how this model of healthcare works in an Indigenous primary health care setting in Australia, we explored the experiences of health staff in an urban Aboriginal Community Controlled Health Service (ACCHS) transitioning to an adapted model of a PCMH. Normalisation Process Theory (NPT) was applied to better understand factors enabling and inhibiting implementation of the PCMH, and the work required to deliver it. ⋯ Applying NPT revealed the characteristics and practice norms of Indigenous community controlled health care as key enablers of implementing a PCMH in an urban ACCHS. Less than optimal resourcing and workforce development emerged as barriers needing to be resolved to strengthen implementation and delivery of a PCMH in this setting.
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Telehealth navigation programmes have shown potential to improve video visit usage and attendance. However, their effectiveness in safety-net healthcare settings remains uncertain. ⋯ Patients unresponsive to outreach had lower portal activation rates and higher non-attendance, suggesting the presence of distinct engagement subgroups within the population. While volunteer-staffed programmes may provide a practical method to reach patients, telephone outreach alone was insufficient to improve video visit usage or attendance rates. Further research is needed to explore alternative or complementary strategies to enhance telehealth engagement in safety-net settings.