Challenges and facilitators for patient and public involvement in England;focus groups with senior nurses

The concepts of patient and public involvement (PPI) have been recognized and linked with quality in health services internationally and in Europe. In England, for more than a decade, NHS policies have increasingly quoted patient-centred services. Limited evidence exists about the implementation of PPI policies and strategies within organisations;three studies only have explored health professionals’ perceptions of PPI. Although nurses’ positive support for patient and public involvement has been noted, comparatively little is known about senior nurses’ experiences of embedding PPI. A national consultation utilising three focus groups aimed to explore senior nurses’ perceptions of challenges and facilitators for PPI implementation. Four Strategic Health Authorities (SHAs) and eleven Primary Care Trusts (PCTs) in England, with fifteen senior nurses with leadership roles and direct PPI experience, participated. Nurses’ perceptions on patient and public involvement, challenges and facilitators for its implementation were discussed. Focus groups were digitally recorded and transcribed verbatim;anonymised transcripts were validated by participants and analysed with thematic analysis. Limited resources, patient representation and recruitment, complexities of implementing PPI and national policy changes were challenging. Commissioning limitations, lack of feedback on patient experience, limited staff awareness, negative attitudes, management of patients and public expectations constituted further challenges. Nursing role characteristics and informal involvement activities, PPI policy and cultural change, commissioning PPI competencies, related service frameworks, providing feedback on patient experiences to staff and recognition of involvement benefits were recognised as facilitators. Findings provided new insights into senior nurses’ experiences and evidence that progress towards meaningful, effective PPI remains slow. However, recognition of existing nursing role characteristics and potential delivery problems created by expanded nursing roles, informal PPI practice and internal organisational sharing of patient feedback may bring an “emerging productive partnership” with nurses enabling and contributing to effective PPI.

The Impact of Salivary pH Value and Dental Caries Index on Periodontal Status among Adult Age Groups of Patients from Aseer Region, Saudi Arabia

Background: The patients’ age is considered a modified risk factor that causes periodontal disease, dental caries, and their development. Objective: The present study was designed to evaluate the impact of salivary pH value and dental caries index on periodontal status among adult age groups of patients from Aseer region, Saudi Arabia. Methods: A cross-sectional analysis carried out in the college of dentistry, King Khalid University on 750 adult patients (400 males and 350 females). The adults patients were divided into three equal groups according to the patients’ age: group I (20 - 30 years), group II (31 - 40 years), and group III (41 - 50 years). Plaque index (PLI), gingival index (GI), clinical attachment loss (CAL), and the dental caries index (DMFT) recorded as well as salivary pH. All findings collected, then analyzed by an ANOVA test and the t-test. A p-value at <0.05 was considered a statistical significance level. Results: The clinical findings of the current study showed that there were statistically significant differences in the patients’ age of both males and females. Moreover, there were statistically significant differences in GI. On the other hand, there were highly statistically significant differences in PLI and DMFS, but there were no significant differences in CAL of both males and females Moreover, there were no statistically significant differences in salivary pH. Conclusion: We concluded that DMFT Index correlated to periodontal and oral health status and, it increased with the progression of the patient’s age and can be used in the epidemiological evaluation of periodontal and oral health status.

DRG支付制度改革对老年患者就诊费用的影响与政策建议

目的:分析南京市某老年病医院DRG付费改革前后医疗数据的变化,通过优化老年病医院的管理策略,可科学利用医保基金、促进医院高质量发展。方法:收集南京市某老年病医院支付制度改革前后住院患者医疗数据,分析制度对老年病医院运营的影响,并对支付制度改革政策优化提出建议。结果:老年病医院患者医疗服务需求与资源消耗随年龄同步增长;DRG支付制度改革推动医院注重绩效进步,CMI提升,住院费用结构发生改变,次均住院费用降低,平均住院日减少(P<0.05)。结论:DRG支付可以合理地控制医院住院费用不合理增长;医院通过科学有效的管理对策可提高医保基金使用效能;DRG政策设计应考虑高龄患者对医疗资源的刚性需求特点进行改革与调整。

美国APG分组与付费对我国门诊支付方式改革的借鉴与启示

目的梳理美国门诊病例分组(ambulatory patient groups,APG)分组方法、付费标准测算过程、费用结算规则,总结APG技术优势与实施要点,为我国门诊支付方式改革提供参考。方法采用文献研究法,剖析美国APG付费技术与实施过程,并与我国部分城市APG试点做法进行初步对比。结果APG 3.18版目录共包含13个大类、61个亚类、666个分组。1个APG病例可以分进多个APG组,通过应用合并、打包、打折等规则,计算最终付费金额。结论美国APG付费技术符合门诊医疗特点,付费方式灵活,促进医疗机构高效服务,对我国门诊支付方式改革有很好的借鉴意义。APG实施要点包括提升门诊数据质量、分组与付费规则本土化、建立监管考核指标体系、做好与住院支付的衔接等。

“患者群”管理联合呼吸训练器在慢性阻塞性肺疾病稳定期患者中的应用效果

目的:探讨“患者群”管理联合呼吸训练器在慢性阻塞性肺疾病稳定期患者中的应用效果。方法:选取2019年1月—2022年7月北京市通州区梨园社区卫生服务中心门诊收治的慢性阻塞性肺疾病稳定期患者66例作为研究对象,以随机数字表法分为试验组、对照组,各33例。对照组进行常规门诊管理,试验组建立“患者群”并联合使用呼吸训练器进行肺康复治疗。比较两组肺功能、干预依从性。结果:干预前,两组第1秒用力呼气容积/预计值%(FEV_(1)%预计值)、FEV_(1)/用力肺活量(FVC)比较,差异无统计学意义(P>0.05);干预后,两组FEV_(1)%预测值、FEV_(1)/FVC均高于干预前,且试验组高于对照组,差异有统计学意义(P<0.05)。干预前,两组Morisky用药依从性量表(MMAS-8)评分比较,差异无统计学意义(P>0.05);干预后,两组MMAS-8评分高于干预前,且试验组高于对照组,差异有统计学意义(P<0.05)。结论:“患者群”管理联合呼吸训练器在慢性阻塞性肺疾病稳定期患者中的应用效果显著,可以改善患者肺功能,提高患者依从性。

基于实验经济学的APG支付对医生医疗行为的影响研究

通过实验经济学方法收集临床相关专业毕业生和研究生的调查问卷,以医学生在按服务项目付费(FFS)和门诊病例分组(APG)支付两种医疗保险支付方式下为不同健康状况和疾病类型的患者提供医疗服务数量的决策模拟,讨论不同支付模式对医生提供医疗服务的影响。结果表明,医生在两种不同支付模式下为不同健康状态和疾病类型患者提供的医疗服务数量均存在显著差异。医生受到FFS模式的激励,往往会为患者提供过多的医疗服务,而APG可以制约医生提供过量医疗服务,医生在APG模式下作出的最优医疗服务决策数量也显著多于FFS模式。而相较于APG,FFS模式能够更好地保障健康状况较差、病情复杂的病例的医疗需求,并提供更全面的医疗服务。建议对常规门诊和常见病例尽量采用APG支付模式,对于情况复杂、严重的病例推进FFS支付作为补充支付方式。

基于ADOPT模式的团体心理干预对老年直肠癌患者自我管理能力、生活质量及希望水平的影响

目的 探讨基于ADOPT模式的团体心理干预对老年直肠癌患者自我管理能力、生活质量及希望水平的影响。方法 依据干预方法的不同将200例老年直肠癌患者分为观察组(n=109)和常规组(n=91),常规组患者给予常规干预,观察组患者给予基于ADOPT模式的团体心理干预。比较两组患者的造口适应情况[造口适应量表(OAS)]、自我管理能力、负性情绪[焦虑自评量表(SAS)和抑郁自评量表(SDS)]、生活质量[欧洲癌症研究与治疗组织生命质量测定量表(EORTC QLQ-C30)]、希望水平[Herth希望量表(HHI)]和满意度。结果 出院时和出院后6个月,两组患者OAS量表各维度评分和总分均高于本组术后1天,且观察组患者OAS量表各维度评分和总分均高于常规组,差异均有统计学意义(P﹤0.05)。出院时,两组患者SAS、SDS评分均低于本组术后1天,肠造口病人自我管理能力问卷、EORTC QLQ-C30、HHI量表各维度评分均高于本组术后1天,观察组患者SAS、SDS评分均低于常规组,肠造口病人自我管理能力问卷、EORTC QLQ-C30、HHI量表各维度评分均高于常规组,差异均有统计学意义(P﹤0.05)。观察组患者的总满意度为98.17%,明显高于常规组患者的89.01%,差异有统计学意义(P﹤0.01)。结论 基于ADOPT模式的团体心理干预可明显缓解老年直肠癌患者的负性情绪,强化患者适应情况和自我管理能力,提高生活质量、希望水平和满意度。

团体心理治疗对缓解期精神分裂症患者的疗效分析

本研究的目的是探讨团体心理治疗对缓解期精神分裂症患者的康复疗效。选择2022年4月至2023年4月在湖南中医药大学第二附属医院住院治疗的缓解期精神分裂症患者80例,随机分成干预组与对照组各40例。两组均维持原来的治疗方案不变,干预组在此基础上增加团体心理治疗。采用阴性症状量表(SANS)和住院精神病患者康复疗效评定量表(IPROS)评定其效果。结果显示,干预组在接受团体心理治疗后,SANS评分有显著下降,尤其是在情感迟钝、社交退缩和语言贫乏三个维度上的改善更为明显。而对照组在治疗期间SANS评分的变化不大,改善程度较小。此外,在IPROS评定量表上,干预组的康复效果显著高于对照组,特别是在社会功能和职业功能的重建方面,干预组患者表现出较好的进步。进一步分析发现,团体心理治疗不仅帮助患者减轻了阴性症状,还增强了他们的自我效能感、社交技能和解决问题的能力。这些结果表明,团体心理治疗能够为缓解期精神分裂症患者提供额外的康复支持,有助于他们更好地融入社会,提高生活质量。

粤北地区脑卒中高危人群筛查和干预项目患者满意度的影响因素分析

目的:分析粤北地区脑卒中高危人群筛查和干预项目患者满意度的影响因素,为粤北地区脑卒中高危人群筛查和干预工作提供理论指导。方法:通过问卷方式对粤北地区接受脑卒中高危人群筛查和干预的305例患者进行满意度调查,时间范围为2022年1月至2023年12月,主要内容包括患者基本情况、满意度评价内容。分析患者满意度分布情况,后采用多因素logistic回归模型分析患者满意度的影响因素。结果:305例患者中,满意组47例(18.22%),不满意组258例(81.78%)。两组患者在危害认知、医护人员态度、就医流程、住院健康教育方式、住院健康教育内容、就医环境、出院教育方式、出院教育内容、就医费用、随访方式、随访次数、复查的满意度方面比较,差异均具有统计学意义(P<0.05)。多因素logistic回归分析结果显示,对危害认知低(OR=4.677,P=0.004)、对就医费用不满意(OR=3.673,P=0.009)是患者满意度的独立危险因素。结论:应充分关注患者对当前脑卒中高危人群筛查和干预项目满意度的影响因素,以危害认知、就医费用为发展导向,健全脑卒中高危人群筛查和干预项目服务体系,满足患者的诊疗服务。

呼吸科护理亚专业小组对重症肠内营养患者营养、肺功能及生活质量的影响

目的:探讨呼吸科护理亚专业小组对重症肠内营养患者营养、肺功能及生活质量的影响。方法:便利抽样选取2020年1月至2021年12月本院呼吸与危重症医学科收治的重症肠内营养患者80例为研究对象,按入院顺序分为对照组和干预组,对照组采用常规护理,干预组由护理亚专业小组实施护理,比较干预前后对照组与干预组的患者在营养评分、肺功能以及生活质量的差异。结果:干预组患者PG-SGA评分较对照组显著改善,干预组患者的FEV1、FEV1%、FVC、FEV1/FVC%指标显著优于对照组,相比于对照组的患者干预组的生活质量在呼吸症状、活动能力、疾病影响及总分方面显著降低,差异显著(P<0.05)。结论:呼吸科护理亚专业小组的建立能够显著改善重症肠内营养患者的营养状况,肺功能得到有效提高,并对患者的生活质量改善有显著作用,值得在临床中进行推广。

巴林特小组嵌入住院医师规范化培训硕士生医患沟通课程的应用探索

目的:探讨巴林特小组嵌入医患沟通课程教学后,对培养住院医师规范化培训硕士生(以下简称“住培专硕”)医患沟通能力和共情能力的应用效果。方法:招募住培专硕一年级学生60名,随机分为实验组和对照组,每组30名。实验组参与嵌入巴林特小组的医患沟通课程教学,对照组仅参与传统医患沟通课程。课程开展前后采用医患沟通技能评价量表(SEGUE)与杰弗逊共情量表学生版(JSPE-S)评价两组医患沟通和共情能力的差异,并在课程结束后,调查两组学生对课程的满意度。结果:医患沟通课程开展前后评分差值方面,实验组在SEGUE量表和JSPE-S量表的总分与各维度得分均高于对照组(P<0.01);实验组SEGUE量表的总分较开展前增长了39.83%(P<0.01),JSPE-S量表的总分较开展前增长了19.51%(P<0.01)。实验组对教学的满意度评价显著高于对照组(P<0.01)。结论:巴林特小组嵌入医患沟通课程教学可有效地提升住培专硕的医患沟通与共情能力,同时提高学生对课程的满意度。

音乐团体治疗对急性精神病患者激躁行为的影响分析

目的 通过单组前后组实验设计数据分析音乐团体治疗对急性精神病患者激躁行為、焦虑抑郁情绪的控制效果。研究样本取自在某三级甲等医院精神科病房住院的急性精神病患者,共纳入患者44人。方法 住院患者参与每周2次,每次1小时的音乐团体治疗,每位患者平均参加6次。使用激躁行为量表、医院焦虑与抑郁量表、整体精神功能状态评估量表等对其进行评分。结果 患者每次进行音乐团体治疗前后激躁行为得分差异具有显著性(P<0.05)。第2周及第4周末,研究组激躁行为、焦虑情绪、抑郁情绪及整体精神功能评分较对照组均有不同程度的改善,差异均具有统计学意义(P<0.05)。结论 精神科病房使用音乐团体治疗可令急性精神病患者心情舒畅,情绪稳定,有效改善其焦躁行为,建议进一步推广。

康复训练对精神分裂症康复期骨质疏松患者跌倒认知及运动依从性的影响

目的:通过临床医学试验研究,分析团体认知康复训练对精神分裂症康复期骨质疏松患者跌倒认知及运动依从性的影响效果。方法:选取我院2021年1月-2023年1月收治的50例精神分裂症康复期骨质疏松患者为研究对象,采用电脑随机分组分为对照组与试验组,各25例。对照组采用常规的护理服务模式,试验组在此基础上给予患者团体认知康复训练。对比2组患者跌倒认知及依从性的影响效果。结果:试验组跌倒效能评分中室内活动、室外活动及总评分均高于对照组,组间差异有统计学意义(P<0.05);试验组跌倒率低于对照组,运动依从性高于对照组,组间差异有统计学意义(P<0.05)。结论:团体认知康复训练护理服务模式对于精神分裂症康复期骨质疏松患者的跌倒认知以及运动依从性要明显优于普通康复护理服务模式。

基于团体游戏疗法的健康教育对老年糖尿病病人的影响

目的:探讨基于团体游戏疗法的健康教育对老年糖尿病病人血糖水平、自我管理知识、态度、行为的影响,为团体游戏疗法在糖尿病健康教育领域的应用提供参考。方法:便利选取2022年7月—11月昆明市某社区卫生服务中心辖区内的老年糖尿病病人60例作为研究对象,随机分为对照组和干预组,各30例。对照组实施社区常规糖尿病健康教育,干预组在对照组的基础上实施基于团体游戏疗法的健康教育,干预3个月。比较两组干预前后的病人的血糖控制情况与病人的自我管理知识、态度和行为的评分,和干预组病人对本研究的满意度评价。结果:干预后,干预组糖化血红蛋白(HbA1c)测量值低于干预前,差异有统计学意义(P<0.05);干预组糖尿病自我管理知识、态度、行为评分明显高于对照组,差异有统计学意义(P<0.05);干预组病人的干预满意度得分为46.00(43.75,48.00),93.30%的病人对本研究干预模式感到非常满意。结论:基于团体游戏疗法的健康教育干预模式在提高老年糖尿病病人的自我管理知识、态度和行为方面的效果优于社区常规健康教育,在降低老年糖尿病病人HbA1c方面也有一定效果;此外,该干预方案实施获得了较高的满意度,为老年糖尿病病人的健康教育提供了新的干预思路。

多元化健康教育对老年慢阻肺稳定期患者呼吸肌群锻炼的作用效果

目的:在多元化健康教育应用后,观察该教育模式对老年稳定期慢性阻塞性肺疾病(Stable chronic obstructive pulmonary disease,sCOPD)患者呼吸肌群锻炼的影响。方法:本研究开展前瞻性研究,将我院2023年1月至2023年11月收治的106例老年sCOPD患者纳入本研究,分成两组,按照随机数字表法进行分组,即A组与B组,其中B组患者行常规健康教育,A组患者在B组基础上采用多元化健康教育。对比两组患者干预前、干预3 m后自我效能感、疾病认知得分情况、最大通气能力(Maximal voluntary ventilation,MVV)及6 min步行距离(Six minutes walk test,6MWT),比较两组干预3 m后呼吸功能锻炼依从性。结果:干预3 m后,两组患者自我效能评分较干预前均有所上升,较之B组,A组各项评分更高,P<0.05。患者经干预3 m后,两组患者疾病知识评分中基本知识、治疗知识、自我护理、肺康复锻炼评分均较干预前上升,A组各项评分高于B组,P<0.05。干预3 m后,两组患者MVV、6MWT水平较干预前上升且A组高于B组,P<0.05;(4)A组患者缩唇呼吸、腹式呼吸、全身性呼吸体操按时做的人数明显高于B组。结论:多元化健康教育对老年sCOPD患者干预效果理想,能够明显提高患者自我效能及认知水平,加强肺功能及肢体运动功能,提升锻炼的依从性。

基于微信平台的线上团体认知管理对妊娠期甲减患者疾病知信行及疾病自我管理能力的影响

目的探讨基于微信平台的线上团体认知管理在妊娠期甲减患者中的应用效果。方法选择2019年4月至2022年2月我院接收的86例妊娠期甲减患者进行研究,以随机数字表法将其分为对照组、观察组,各43例。对照组接受常规护理,观察组在对照组护理方案基础上加施基于微信平台的线上团体认知管理。比较两组的干预效果。结果干预后,观察组的知识、信念及行为评分高于对照组(P<0.05)。干预后,观察组的成年人健康自我管理能力测评量表(AHSMSRS)各维度评分高于对照组(P<0.05)。干预后,观察组的促甲状腺激素(TSH)、促甲状腺激素受体抗体(TRAb)水平低于对照组(P<0.05)。观察组的不良妊娠结局总发生率低于对照组(P<0.05)。结论基于微信平台的线上团体认知管理用于妊娠期甲减患者护理管理中,不仅可提高患者的疾病知信行水平及疾病自我管理能力,还能促进甲状腺功能恢复,减少不良妊娠结局。

南昌市总额控制下按病组分值付费医保支付方式改革实践

医保支付方式改革是深化医改的重要环节。南昌市于2020年开始实行总额控制下按病组分值付费的医保支付方式改革,取得良好成效。医保统筹基金支出运行平稳,定点医疗机构医保资金略有盈余,对定点医疗机构约束效果明显,人均住院费用和平均住院天数均不同程度下降,引导医疗机构主动合理控费。后续需要精细化设置质量系数考核指标,制定激励措施鼓励医疗新技术新项目的开展。

Palliative chemotherapy for gastroesophageal cancer in old and very old patients: A retrospective cohort study at the National Center for Tumor Diseases, Heidelberg

AIM:To investigate the outcome of palliative chemotherapy in old patients with gastroesophageal cancer at the National Center for Tumor Diseases,Heidelberg.METHODS:Using a prospectively generated database,we retrospectively analyzed 55 patients≥70years under palliative chemotherapy for advanced gastroesophageal cancer at the outpatient clinic of the National Center for Tumor Diseases Heidelberg,Germany between January 2006 and December2013.Further requirements for inclusion were(1)histologically proven diagnosis of gastroesophageal cancer;(2)advanced(metastatic or inoperable)disease;and(3)no history of radiation or radiochemotherapy.The clinical information included Eastern Cooperative Oncology Group performance status(ECOG PS),presence and site of metastases at diagnosis,date of previous surgery and perioperative chemotherapy,start and stop date of first-line treatment,toxicities and consecutive dosage reductions of first-line treatment,response to first-line therapy,date of progression,usage of second-line therapies and date and cause of death.Survival times[progression-free survival(PFS),overall survival(OS)and residual survival(RS)]were calculated.Toxicity and safety were examined.Prognostic factors including ECOG PS,age and previousperioperative treatment were analyzed.RESULTS:Median age of our cohort was 76 years.86%of patients received a combination of two cytotoxic drugs.76 percent of patients had an oxaliplatin-based first-line therapy with the oxaliplatin and 5-fluorouracil regimen being the predominantely chosen regimen(69%).Drug modifications due to toxicity were necessary in 56%of patients,and 11%of patients stopped treatment due to toxicities.Survival times of our cohort are in good accordance with the major phaseⅢtrials that included mostly younger patients:PFS and OS were 5.8 and 9.5 mo,respectively.Survival differed significantly between patient groups with low(≤1)and high(≥2)ECOG PS(12.7 mo vs 3.8 mo,P<0.001).Very old patients(≥75 years)did not show a worse outcome in terms of survival.Patients receiving secondline treatment(51%)had a significantly longer RS than patients with best supportive care(6.8 vs 1.4 mo,P=0.001).Initial ECOG PS was a strong prognostic factor for PFS,OS and RS.CONCLUSION:Old patients with non-curable gastroesophageal cancer should be offered chemotherapy,and ECOG PS is a tool for balancing benefit and harm upfront.Second-line treatment is reasonable.

Diversity and Scope of Senior Nurses’ Informal and Formal Experiences of Patient and Public Involvement in England

Patient and public involvement (PPI) has been recognized internationally. In England, NHS policies have increasingly emphasized the importance of patient-centered services, but limited evidence exists about the implementation of PPI policies and strategies within organizations. Few studies have explored health professionals’ perceptions of PPI and comparatively little is known about the experience of senior nurses. A national consultation utilising three focus groups aimed to explore senior nurses’ PPI experience. Four Strategic Health Authorities (SHAs) and eleven Primary Care Trusts (PCTs) in England, with fifteen senior nurses with leadership roles and direct PPI experience, participated. Focus groups were digitally recorded and transcribed verbatim;anonymised transcripts were validated by participants and analysed with thematic analysis. Sixteen categories emerged within five sub-themes of PPI experience: provision of information and raising awareness (1 category), informal generic PPI-activities not perceived as PPI (3 categories), formal generic PPI (3 categories), involvement of specific groups (5 categories) and PPI in commissioning and strategy (4 categories). Findings provided new insights into senior nurses’ experiences and evidence that progress towards meaningful, effective PPI remains slow. Nurses performed PPI in a pragmatic sense, by virtue of the nature of nursing, but they did not recognise or label these activities as such. However, a plethora and variety of innovative activities formally recognised as patient and public involvement were undertaken, together with specific networks and groups’ involvement, and involvement linked to commissioning and strategy. Enhancing awareness of nurses through education, together with monitoring and feedback mechanisms could support the PPI implementation and effectiveness at organisations.