Background: Patient satisfaction is one of the key patient-reported indicators of healthcare quality. In the study, we assess satisfaction with visits to primary healthcare (POZ) and specialised ambulatory healthcare (AOS). Methods: This web-based cross-sectional study was conducted in a representative sample of 725 patients from the Polish population in June 2023. The study employed the Patient Expectations Scale, comprising 18 statements addressing various aspects of a medical visit. Results: The average satisfaction rating for the medical visit was 7.41 (±2.34) out of 10, with a median of 8. Strong correlations were found between overall visit satisfaction and specific aspects of the doctor-patient interaction. The highest correlations were observed for expressions of empathy and support, such as "showed concern" (r = 0.73) and "encouraged me" (r = 0.68), as well as for clear communication about treatment ("presented a probable course of treatment" (r = 0.62) and disease consequences (r = 0.55). Presenting test results (r = 0.51) and treatment recommendations (r = 0.63) were also significantly associated with overall satisfaction (all p < 0.001). Conclusions: This study shows that patients reported higher satisfaction with specialised ambulatory care (AOS) than with family medicine (PR), mainly due to better communication, encouragement and concern from AOS doctors. Improving healthcare quality in Poland requires not only financial and organisational efforts but also a focus on patient expectations, supported by regular use of satisfaction measurement tools.

A novel volunteer program was implemented in the adult emergency department waiting room to combat declining patient satisfaction, a crucial quality metric impacting everything from hospital reimbursement to clinical outcomes. Net Promotor Scores (NPS) were tracked in a retrospective cohort design, with patients interacting with volunteers serving as the intervention cohort and those who did not serving as control. Analysis using monthly NPS means was conducted from 2022 to 2023. The absolute difference in NPS between the 2 groups was 17.43. Using monthly means, an unpaired t -test was conducted. NPS in the intervention group was 51.86 with a standard deviation of 7.01. NPS in the control was 34.43 with a standard deviation of 5.32. Data is significant, with P = 0.0002. This emergency department waiting room volunteer program led to increases in patient satisfaction. Study authors think similar effects are achievable at other institutions, and future trials would be beneficial in confirming this suspected causal relationship.

Despite rapid urbanization, no researchers have focused on patients with hypertension in urban-rural fringe areas, where rural characteristics are retained but the influences of urbanization are typically found.

In this study, we aimed to reduce health inequities by examining the status quo of health-related quality of life (HRQOL), high blood pressure-specific health literacy (HBP-HL), and social support and self-management and to explore how HBP-HL influences HRQOL among patients with hypertension in urban-rural fringe communities.

Four hundred six patients with hypertension completed physical examinations and HBP-HL, HRQOL, self-management, and social support assessments via in-person interviews. Bootstrap multiple mediating effect analysis was used to explore associations between HBP-HL and HRQOL.

Only 24.2% of participants had a high HRQOL. None of the participants had adequate HBP-HL, only 23.2% had limited HBP-HL, and 76.8% had moderate HBP-HL. The HBP-HL score was directly correlated with HRQOL (β = 0.802; 95% confidence interval, 0.344-1.259) and indirectly correlated with HRQOL via social support (β = 0.368; 95% confidence interval, 0.202-0.568) and self-management (β = 0.314; 95% confidence interval, 0.102-0.560). The total contribution rate of the mediating effect was 41.4%.

The HRQOL and HBP-HL scores of patients with hypertension were intermediate and inadequate, respectively. In addition, HBP-HL directly and indirectly influenced HRQOL through social support and self-management. Health providers should screen for inadequate HBP-HL in patients with hypertension before intervention. Health-promoting interventions involving HBP-HL as a breakthrough point should be tailored to control blood pressure and improve HRQOL.

Trauma to the anal sphincter following vaginal birth increases the risk of anal incontinence. Laxative management in the postnatal period is recommended to improve defecation and reduce the risk of wound breakdown. Research underpinning management guidelines is lacking and omits end-users (clinicians and birthing women) involvement in evaluating pilot studies. Incorporating end-users' enhances the relevance of the research to those being investigated, improves the design, and translation of findings into clinical practice. No studies have evaluated end-users' experiences in research which investigates laxative management following anal sphincter injury.

This study identifies the barriers and facilitators in a pilot study research design and suggests improvements to inform larger scale research to improve clinical practice.

A phenomenological qualitative study using semi-structured interviews was adopted. Purposeful sampling of health professionals (n = 85) involved in the direct care of women following OASIs and women (n = 64) sustaining OASIs during the recent pilot trial. Data analysis employing thematic analysis.

The consensus from interviews (n = 23) highlighted the research was feasible with suggested improvements to enhance future recruitment, information for linguistically diverse women and review of quality-of-life tools. The evaluation process enhanced future research engagement.

The reliability and validity of future research can be improved adopting a qualitative framework and end-users' to evaluate pilot studies. Findings from this pilot study identified issues including recruitment, CALD participant information and accuracy of QoL data collection tools that needed to be addressed enhancing future findings that are relevant to the needs of the study population and enhance translation into practice.

To explore the influence of patient-provider communication on patient self-management of chronic illness.

Systematic Mixed Studies Review.

CINAHL, Google Scholar, EMBASE and PubMed were searched until March 2024.

Employed a result-based convergent design and the Mixed Method Appraisal Tool to evaluate studies. Narrative analysis, quantitative studies and thematic analysis for qualitative studies and overall results.

Thirteen articles published between 2003 and 2023 were included. Chronic illnesses studied: diabetes, heart failure, hypertension, chronic obstructive pulmonary disease and asthma. Data synthesis yielded the overarching theme: adaptive interpersonal communication. An approach that adapts communication content to each patient's unique needs, employs verbal and nonverbal communication, builds a connection and establishes patient rapport.

Available evidence suggests that patient-provider communication influences chronic illness self-management. A provider's ability to adjust and tailor their communication style is an important factor in helping patients to achieve optimal self-management. Future research should explore this phenomenon in other common chronic illnesses not included in this review. Additionally, research on the patient's role in this process could help improve patient-provider communication.

Findings from this review have significant implications for shared and participatory decision making, where patients and providers collaborate to develop plans of care for patients to achieve optimal self-management. Additionally, this review can contribute to the development of educational content and communication strategies for nurses and all healthcare professionals caring for patients with chronic illnesses.

This is the first mixed studies systematic review to describe the influence patient-provider communication on patient self-management of chronic illness. These findings consolidate existing evidence, providing a pathway for practical application to clinical practice and the potential to significantly impact the delivery of patient-centred care and healthcare quality.

No patient or public contribution.

This study assesses the impact of initial messaging strategies on medication behavior in newly diagnosed hypertension patients in a hypothetical context. Applying Construal Level Theory, this study evaluated which message type-low construal (focused on how, feasibility, and concrete) or high construal (focused on why, desirability, and abstract)-is more effective.

An online quasi-experiment was performed with 1200 participants without hypertension aged 30-60. The participants were divided into two message groups, each receiving a hypothetical hypertension diagnosis during a health check-up and different medication messages tailored to construal levels.

Compared to "how" messages, "why" messages significantly improved message satisfaction (F1,1192 = 10.36, p = 0.001, ηp2 = 0.009, M (SE) = 5.25 (0.04) vs. 5.04 (0.04)) and adherence intentions (F1,1192 = 7.54, p = 0.006, ηp2 = 0.006, M (SE) = 4.83 (0.06) vs. 4.59 (0.06)).

In the hypothetical scenario, patients newly diagnosed with hypertension were found to be more responsive to "why" messages and perceived a distant psychological distance to medication.

To enhance adherence intentions and message satisfaction, healthcare professionals should emphasize the reasons and benefits of medication use for newly prescribed hypertension patients. Moreover, early-stage patient materials should prioritize "why" messages to improve adherence.

Hypertension is a chronic disease that requires strict adherence to therapeutic recommendations. While some studies have shown an association between hypertensive patient satisfaction and treatment adherence, research on the relationship between multi-dimensional satisfaction and patient adherence to medication as well as non-pharmaceutical treatment remains limited. This study aimed to examine the association among multiple dimensions of patient satisfaction and adherence among patients with hypertension in rural China.

The research has a cross-sectional study design. A multi-stage, stratified random sampling approach was employed to survey a cohort of 2350 patients with hypertension in rural China. Patient satisfaction and adherence were measured using the instrument of European Task Force on Patient Evaluation of General Practice (EUROPEP) and the Treatment Adherence Scale for Hypertension Patients (TASHP). Multiple linear regression analysis was performed to identify factors influencing patient adherence, while structural equation modeling (SEM) was conducted to elucidate the relationships among various dimensions of patient satisfaction and adherence.

Our findings indicate that patient satisfaction with clinical behavior was positively associated with medication adherence (β = 0.088, p < 0.05) and non-pharmaceutical treatment adherence (β = 0.152, p < 0.01). Patient satisfaction with continuity and cooperation also had a positive influence on medication adherence (β = 0.177, p < 0.01) and non-pharmaceutical treatment adherence (β = 0.134, p < 0.01). However, although patient satisfaction with the organization of care had a negative impact on medication adherence (β=-0.259, p < 0.01), it did not affect non-pharmaceutical treatment adherence. Further, patient adherence was associated by region, age, level of education, course of the disease, and self-reported health status.

Our study highlights the importance of understanding the differential effects of patient satisfaction on adherence in rural China. To improve the management of patients with hypertension in rural areas, primary care institutions should focus on enhancing their capacity, improving the level and capabilities of their chronic disease management team members, promoting effective doctor-patient communication, and providing personalized health education.

Shoulder pain frequently presents as a low priority case in the Emergency Department (ED). However, this is associated with many potential aetiologies, including sickle cell crisis. A thorough history taking and comprehensive assessment, along with an open-minded approach can enhance clinical decision-making processes when caring for patients presenting with shoulder pain.

A 35-year-old male presented to the ED with left shoulder pain. He was given a low priority score as he did not report any significant previous history or trauma, appeared well, and reported a low pain score at the time of presentation.

The open-minded approach by the Advanced Nurse Practitioner led to an appropriate diagnosis, pain management, care, and follow up for the patient.

This case underscored the critical importance of 'probe and probe again' until a clear rationale emerged for the aetiology of the shoulder pain experienced by a young and healthy patient.

Hurried encounters in clinical settings contribute to dissatisfaction among both patients and clinicians and may indicate and contribute to low-quality care. We sought to identify patient- or clinician-reported instruments concerning this experience of time in clinical encounters.

We searched multiple databases from inception through July 2023. Working in duplicate without restrictions by language or clinical context, we identified published instruments or single items measuring perceptions of time adequacy in clinical encounters. We characterized these by time domain (perceived duration or pace of the encounter), responder (patient or clinician), and reference (experience of care in general or of a particular encounter).

Of the 96 instruments found, none focused exclusively on perception of time adequacy in clinical encounters. Nonetheless, these instruments contained 107 time-related items. Of these, 81 items (77 %) measured the perception of the encounter duration, assessing whether there was adequate consultation time overall or for specific tasks (e.g., listening to the patient, exploring psychosocial issues, formulating the care plan). Another 19 (18 %) assessed encounter pace, and 7 (7 %) assessed both duration and pace. Pace items captured actions perceived as rushed or hurried or the perception that patients and clinicians felt pressed for time or rushed. Patients were the respondents for 76 (71 %) and clinicians for 24 (22 %) items. Most patient-reported items (48 of 76) referred to the patient's general care experience.

There are existing items to capture patient and clinician perceptions of the duration and/or pace of clinical encounters. Further work should ascertain their ability to identify hurried consultations and to detect the effect of interventions to foster unhurried encounters.

The available items assessing patient and clinician perceptions of duration and pace can illuminate the experience of time adequacy in clinical encounters as a target for quality improvement interventions. These items may capture unintended consequences on perceived time for care of interventions to improve healthcare access and efficiency.

The objective of this study was to examine the causal relationship between the usage of patient portals and patients' self-care self-efficacy and satisfaction in care outcomes in the context of cancer care.

The National Institute's HINTS 5 Cycle 1-4 (2017-2020) data were used to perform a secondary data analysis. Patients who reported being ever diagnosed with cancer were included in the study population. Their portal usage frequency was considered as an intervention. Patient's self-care self-efficacy and satisfaction in care were the primary outcomes considered and they were measured by survey respondents' self-reported information. A set of conditional independence tests based on the causal diagram was developed to examine the causal relationship between patient portal usage and the targeted outcomes.

A total of 2579 were identified as patients with cancer or cancer survivors. We identified patient portals' impact on strengthening patients' ability to take care of their own health (P = .02, for the test rejecting which is necessary for the expected causal relationship, ie, the portal usage impacts the target outcome; P = .06, for the test rejecting which is necessary for the reverse causal relationship), and we identified heterogenous causal relationships between frequent patient portal usage and patients' perceived quality of care (P = .04 and P = .001, for the tests rejecting both suggests heterogeneous causal relationships). We could not conclusively determine the causal relationship between patient portal usage and patients' confidence in getting advice or information about health or cancer care related topics (P > .05 for both tests, suggesting inconclusive causal directions).

The results advocate patient portals and promote the need to provide better support and education to patients. The proposed statistical method exploits the potential of national survey data for causal inference studies.

Race is a consequential sociocultural cue in healthcare contexts. Racism is associated with health disparities by influencing patient-provider communication and utilization of healthcare services.

This study aimed to investigate how Asian American subgroups differ in their perception of everyday racism, internalized racism, and perceived racism in healthcare settings and whether these perceptions predict their interactions with their health care providers and their utilization of healthcare services.

An online survey study was conducted. ANOVA tests were employed to compare the differences in perceptions of everyday racism, internalized racism, and perceived racism in the healthcare system among Filipino (N = 310), Japanese (N = 242), Chinese (N = 287), Asian Indian (N = 304), Korean (N = 199) and Vietnamese (N = 151) participants. Multiple regression analyses assessed whether perceptions of everyday racism, internalized racism, and perceived racism in the healthcare system predicted healthcare service utilization and patient-provider communication among the Asian subgroups sampled.

There were significant group differences in perceived everyday racism (F = 8.56, p < .001), internalized racism (F = 3.46, p < .01), perceived racism in healthcare (F = 4.57, p < .001). Perceptions of racism and socioeconomic variables were found to predict patient-provider communication and utilization of healthcare services disparately across various Asian subgroups. For instance, the perception of everyday racism was a significant predictor of patient-provider communication for each of the subgroups, excluding the Vietnamese participants. Internalized racism was a significant predictor only for Filipino and Chinese participants. Surprisingly, perceived racism in healthcare was not a predictor for any of the subgroups.

Findings highlight the complex interplay of sociodemographic factors and perceived racism in shaping patient-provider communication and healthcare service utilization within the Asian American community. Implications are suggested for addressing the unique challenges faced by different Asian American subgroups and for promoting equitable healthcare access and fostering positive patient-provider relationships among the Asian American subgroups.

Preclinical simulation is an evidence-based method for nurse practitioner (NP) students to improve clinical communication and disease management competency. During simulation, students may receive feedback from multiple sources, including standardized patients (SPs), faculty, peers, and themselves. Although evidence supports simulation with multisource feedback, its impact on clinical knowledge and communication has yet to be evaluated among NP students. We designed, implemented, and evaluated a preclinical simulation program with structured multisource feedback integrated into a disease management course within a Doctor of Nursing Practice curriculum. Differences in communication self-efficacy and disease management knowledge before and after participation, as well as perceptions of learning and importance of varying feedback sources, were evaluated using a single group pre-post mixed-methods design. On average, clinical communication self-efficacy was significantly higher, and disease management knowledge scores were significantly higher after participation. Learners rated feedback sources as important or very important and described varying feedback sources as complementary. Feedback from SPs, peers, learners themselves, and faculty was complementary and important to learning. This preclinical simulation program with purposeful integration of multisource feedback provides an evidence-based foundation for scaffolding multidomain competency development into curriculums to meet updated standards of advanced nursing education.

Reduction mammaplasty can provide symptomatic relief to patients suffering from macromastia; however, complications such as dehiscence are common. It is unknown if the presence of complications affects patient-reported outcomes.

The aim of this study was to determine the risk factors for the development of complications, and to examine the correlation between postoperative complications and patient-reported outcomes in reduction mammaplasty.

A single-center retrospective chart review was undertaken of patients who received reduction mammaplasties (CPT 19318), performed by 13 surgeons, between January 2017 and February 2023. Breast cancer cases and oncoplastic reconstructions were excluded. Patients with >1 complication were grouped into the complications cohort. Satisfaction was assessed by administering the BREAST-Q survey.

A total of 661 patients were included for analysis, 131 of whom developed at least 1 complication. Patients in the group with complications had significantly higher average ages and BMIs, and a higher likelihood of hypertension and diabetes (P < .01). Among 180 BREAST-Q responders, 41 had at least 1 complication. There were no significant differences between the 2 groups (complications vs no complications) across survey outcomes. Although obese patients were more likely to develop infection and require revisions (P < .01), no significant differences in subgroup analysis of patient-reported outcomes focusing on obese patients were observed.

Obesity, hypertension, and diabetes were associated with postoperative complications of reduction mammaplasty. Patients with complications had similar postoperative BREAST-Q satisfaction to patients without complications. Although risk optimization is critical, patients and surgeons should be reassured that satisfaction may be achieved even in the event of a complication.

Effective communication between doctors and patients is crucial for the well-being of individuals diagnosed with cancer. This study aimed to develop and validate a cancer-specific Doctor-Patient Communication Satisfaction Scale (DPCSS-Cancer) from the patients' perspective.

Initial items were generated through literature review. Content validity was assessed via feedback from five experts, while face validity was determined through cognitive interviews with 13 patients. The revised DPCSS-Cancer was subsequently tested in a sample of 200 cancer patients to assess test-retest stability, internal consistency, factor structure, and criterion-related validity.

The development process resulted in a 15-item DPCSS-Cancer across two dimensions, using a 4-point rating scale (1 = strongly disagree to 4 = strongly agree). The item-level Content Validity Index (I-CVI) ranged from 0.8 to 1.0, with a scale-level CVI of 0.96. Following expert and patient feedback, no items were eliminated, but modifications were made to item wording. In formal testing, the overall Cronbach's alpha was 0.96, with 0.89 for the first dimension and 0.95 for the second. Test-retest reliability was established at 0.82. The two-dimensional structure was partially confirmed. Criterion-related validity was supported through a significant positive correlation with a measure of trust in the physician (r = 0.86). Factors contributing to higher DPCSS-Cancer scores were identified.

The DPCSS-Cancer shows satisfactory reliability and validity, making it a viable patient-reported outcome measure for assessing cancer patients' satisfaction with doctor-patient communication.

Autonomous and patient-centered health communication (PCHC) between a healthcare provider (HCP) and a client (HCC) is a critical fundament for successful healthcare outcomes. A standard and validated data collection tool for studying the satisfaction of Iranian breast cancer patients (BCPs) with various aspects of their health communication with HCPs does not exist. The current study assessed the application, feasibility, and cultural appropriateness of the Persian-translated version of the interview satisfaction questionnaire (ISQ) in the Iranian context. A standard translation/back-translation procedure was used to prepare a preliminary Persian version of the ISQ (ISQ-P) which was then evaluated for content and face validity by a panel of experts. The study data were collected from 200 breast cancer patients and used to estimate the internal consistency measure of Cronbach's alpha and intra-class correlation coefficient. Confirmatory factor analysis (CFA) was performed to verify the compatibility of the instrument's identified dimensions with the original ISQ's factor structure. The calculated content validity index (CVI = 0.89), content validity ratio (CVR = 0.49), and Cronbach's alpha coefficient (0.79) indicated the appropriateness of the ISQ-P for its intended purpose. The CFA's outputs (root mean square error of approximation (RMSEA) = 0.09, comparative fit index (CFI) = 0.954, Tucker-Lewis index (TLI) = 0.931, standardized root mean square residual (SRMR) = 0.04) affirmed the fitness of the study data to the original 4-factor conceptual model. The study findings supported the suitability of ISQ-P for assessing health communication episodes by Persian-speaking BCPs. However, due to cultural variation, cross-border diversity of health systems, and organizational circumstances, further validity and reliability appraisal of the ISQ-P in distinct sub-samples is recommended.

This study aimed to assess medication adherence among Jordanian patients with dyslipidemia and evaluate the impact of health literacy, well-being, and doctor-patient communication on adherence in this population. Dyslipidemia is a prevalent condition that significantly increases the risk of cardiovascular diseases, and understanding the factors influencing medication adherence is crucial for improving patient outcomes.

An observational cross-sectional study was conducted from March to July 2023. A convenience sample of adult Jordanians diagnosed with dyslipidemia was surveyed in a tertiary hospital using validated scales: the Lebanese Medication Adherence Scale-14 (LMAS-14), the Doctor-Patient Communication Scale (DPC), the WHO well-being index, and the health literacy scale. Bivariate analysis and linear regression models were employed to analyze associations.

Among 410 participants (mean age 58.62 ± 12.11 years), the mean scores were LMAS-14 (35.10), DPC (55.77), WHO well-being (47.53), and health literacy (38.96). Higher medication adherence was associated with older age (B = 0.093, p = 0.049), university education (B = 2.872, p = 0.017), prior surgery (B = 2.317, p = 0.021), medium income level (B = 3.605, p = 0.006), and better doctor-patient communication (B = 0.166, p = 0.003). Conversely, cigarette smoking (B = -3.854, p = 0.001) and health insurance (B = -2.146, p = 0.039) were linked to lower adherence.

The findings underscore the substantial interplay of socio-demographic and clinical factors affecting medication adherence. Enhanced public health interventions focusing on improving health literacy, communication quality, and addressing socio-economic conditions are vital for better adherence and patient outcomes in Jordan.

This study aimed to evaluate the effects of an artificial intelligence (AI) chatbot (ChatGPT-3.5, OpenAI) on preoperative anxiety reduction and patient satisfaction in adult patients undergoing surgery under general anesthesia.

The study used a single-blind, randomized controlled trial design.

In this study, 100 adult patients were enrolled and divided into two groups: 50 in the control group, in which patients received standard preoperative information from anesthesia nurses, and 50 in the intervention group, in which patients interacted with ChatGPT. The primary outcome, preoperative anxiety reduction, was measured using the Japanese State-Trait Anxiety Inventory (STAI) self-report questionnaire. The secondary endpoints included participant satisfaction (Q1), comprehension of the treatment process (Q2), and the perception of the AI chatbot's responses as more relevant than those of the nurses (Q3).

Of the 85 participants who completed the study, the STAI scores in the control group remained stable, whereas those in the intervention group decreased. The mixed-effects model showed significant effects of time and group-time interaction on the STAI scores; however, no main group effect was observed. The secondary endpoints revealed mixed results; some patients found that the chatbot's responses were more relevant, whereas others were dissatisfied or experienced difficulties.

The ChatGPT intervention significantly reduced preoperative anxiety compared with the control group; however, no overall difference in the STAI scores was observed. The mixed secondary endpoint results highlight the need for refining chatbot algorithms and knowledge bases to improve performance and satisfaction. AI chatbots should complement, rather than replace, human health care providers. Seamless integration and effective communication among AI chatbots, patients, and health care providers are essential for optimizing patient outcomes.

Oral healthcare is attracting much attention after decades of neglect from policymakers. Recent studies have shown a strong association between oral and overall health, which can lead to serious health problems. Availability of oral healthcare services is an essential part of ensuring universal healthcare coverage. More importantly, current gaps in its accessibility by minority or marginalized population groups are crucial public health as well as ethical concerns. One notable effort to address this issue comes from Non-Governmental Organizations (NGOs), which offer oral healthcare services for non-insured refugees. However, the challenge remains that these care services are not comprehensive, which has implications for the refugees' oral and general health. In this article, we discuss this complex issue in the German healthcare context by including ethical reflections. Therefore, the purpose of this article is to discuss the ethical challenges related to oral healthcare services provided by NGOs for refugees in Germany. First, we will introduce the general oral healthcare context worldwide and in Germany. Second, we will provide a general description of the oral healthcare services provided by NGOs for refugees in Germany, as well as an overview of existing gaps. This will provide us with the context for our third and most important task-discussing the ethical implications of the gaps. In doing so, and since the ethical implications can be several, we demarcate the scope of our analysis by focusing on the specific ethical issues of justice, harm, and autonomy. Finally, we offer some recommendations for how to move forward.

Physician-Patient communication (PPC) has been linked to patient adjustment outcomes. However, conflicting results have been reported and previous systematic reviews showed some methodological weaknesses. It has also been suggested that PPC is related to physicians' own adjustment outcomes. This systematic review aims to explore and synthesize the associations between PPC and both patient and physician adjustment outcomes. A systematic search was conducted primarily in five databases and 11.488 non-duplicated articles were identified. Forty-five studies met the eligibility criteria and data extraction was performed for sample characteristics, PPC measurement, adjustment outcomes under examination and main outcomes. The observed results showed that the majority of the included studies were cross-sectional, assessed PPC by proxy-report and reported an overall positive association with patients' adjustment outcomes. None of the studies examined the association between PPC and physicians' adjustment outcomes. Thirty-three studies were meta-analyzed and showed a positive and significant association between PPC and patients' adjustment outcomes (r = .16). Due to the small number of studies included in the meta-analysis, the heterogeneity was high. Subgroup analysis could not identify sources for heterogeneity. Research on the associations between PPC and physicians' own adjustment outcomes is warranted. Future studies should be rigorous in defining clear PPC definitions, directionality of communication processes, and study design.

To identify communication strategies that may improve clinician-patient interactions, we assessed the association between clinician response to emotion and patient ratings of communication.

From a cohort of 1817 clinician-patient encounters, we designed a retrospective case-control study by identifying 69 patients who rated their interpersonal care as low-quality and 69 patients who rated their care as high-quality. We used the Verona Coding Definitions of Emotional Sequences (VR-CoDES) to identify patient emotional expressions and clinician responses. Using mixed-effects logistic regression, we evaluated the association between clinician responses to patients' emotions and patient ratings of their interpersonal care.

In adjusted analyses, explicit responses that reduced space for further emotional communication were associated with high ratings of care (OR 1.94, 95% CI 1.25, 2.99); non-explicit responses providing additional space were associated with low ratings (OR 0.54, 95% CI 0.36-0.82). In terms of specific response types, neutral/passive responses were associated with low ratings (OR 0.59, 95% CI 0.39-0.90), whereas giving information/advice was associated with high ratings (OR, 95% 1.91 CI 1.17-3.1).

Patients may prefer responses to their expressed emotions that demonstrate clinician engagement, with or without expressions of empathy.

These findings may inform educational interventions to improve clinician-patient communication.

Is conducting a randomized control trial (RCT) to assess the effectiveness of whole-system naturopathy in improving pregnancy rates among women with diminished ovarian reserve (DOR) feasible?

A two-arm, parallel group, assessor-blinded feasibility RCT was conducted. Women with DOR, trying to conceive naturally or by ART, were randomly assigned to naturopathy plus usual care, or usual care alone for 16 weeks. Primary outcomes were feasibility (recruitment, adherence, retention rates), acceptability and safety. Secondary outcomes included ongoing pregnancy rates, live birth rates and health-related outcomes (mental health, quality of life, diet, exercise, sleep and weight). Statistical significance of the differences between the two groups (P-values) were exploratory.

One hundred and fifteen women completed the screening survey between March and November 2022. Of these, 66 women were assessed for eligibility and 41 (62%) consented. Recruitment resulted in seven enrolments each month. All 41 participants (100%) adhered to the intervention, 38 (93%) completed end-point questionnaires, 32 (78%) found study participation to be acceptable and 18 out of 21 (86%) from the intervention group would recommend a naturopathic intervention to other women with DOR. The naturopathic treatment was associated with only mild and temporary adverse events. No between-group differences were observed for pregnancy and live birth rates.

The evaluation of whole-system naturopathy through a RCT was feasible and the treatment was acceptable and well tolerated according to women with DOR. Outcomes from this study will help inform sample size calculations powered for fertility outcomes for future RCTs on this topic.

Hypertension is an important cardiovascular disease risk factor. Blood pressure control for hypertensive patients is crucial to prevent hypertension related complications. Ensuring and assessing self-care of hypertensive patients is important for blood pressure control and hypertension management. The Self-care of Hypertension Inventory (SC-HI) is an inventory developed for assessing self-care of hypertensive individuals. SC-HI has three subscales; maintenance, monitoring and management.

The aim of this study was to conduct Turkish version of SC-HI Version 3.0 (SC-HI V3.0) and assessing its psychometric properties for adults with hypertension.

We included 120 hypertensive patients in this methodological study. SC-HI V3.0 translated Turkish and tested for reliability and validity. To analyse structural validity item-total correlations and factor analyses was used. Intraclass correlation coefficient (ICC) method was selected for analysing scale's consistency and convergent validity was conducted.

The mean age of participants were 54.74 ± 7.19 years and the mean duration from hypertension diagnosis were 38.19 ± 19.42 months. Translated Turkish version's factor loadings were ranged between 0.419 and 0.841. Cronbach's alpha coefficient values were 0.661, 0.880, 0.805 and ICC values were 1.0, 0.99, 0.99 for maintenance, monitoring and management, respectively. Convergent validity's correlation coefficients weak to very strong and statistically significant.

Turkish version of the SC-HI Version 3.0 is reliable, valid and useful scale for assessing self-management in hypertensive adults for clinical practice and research purposes.

Social determinants of health (SDoH) are key factors that impact health outcomes. However, there are many barriers to collecting SDoH data (eg, cost of data collection, technological barriers, and lack of standardized measures). Population data may provide an accessible alternative to collecting SDoH data for patients.

To explain how population data can be leveraged to create SDoH measures, assess the association of population SDoH measures with diabetic medication adherence, and discuss how understanding a patient's SDoH can inform care plans and patient engagement.

A nationally representative commercial sample of patients who were aged 18 years and older and met Pharmacy Quality Alliance inclusion criteria for diabetes mellitus were analyzed (N = 37,789). US Census and North American Industry Classification System data were combined with pharmacy administrative claims data to create SDoH measures. Derived measures represent 2 SDoH domains: (1) economic stability (housing density, housing relocation, jobs per resident, and average salary) and (2) health care access and quality (urban/rural classification, distance traveled to prescriber and pharmacy, use of a primary care provider [PCP], and residents per PCP). The association of population SDoH measures with diabetic medication adherence (proportion of days covered) was assessed via logistic regression, which included covariates (eg, sex, age, comorbidities, and prescription plan attributes).

As housing density (houses per resident) increased, so did the likelihood of adherence (odds ratio = 1.54, 95% CI = 1.21-1.97, P = 0.001). Relative to patients who did not move, patients who moved once had 0.87 (95% CI = 0.81-0.93, P < 0.001) the odds of being adherent, and patients who moved 2 or more times had 0.82 (95% CI = 0.71-0.95, P = 0.008) the odds of being adherent. Compared with areas with fewer jobs per resident, patients living within a zip code with 0.16 to 0.26 jobs per resident were 1.12 (95% CI = 1.04-1.20, P = 0.002) times more likely to be adherent. Patients who lived in an urban cluster were 1.11 (95% CI = 1.01-1.22, P = 0.037) times more likely to be adherent than patients living in a rural area. Patients who travel at least 25 miles to their prescriber had 0.82 (95% CI = 0.77-0.86, P < 0.001) the odds of being adherent. Community pharmacy users had 0.65 (95% CI = 0.59-0.71, P < 0.001) the odds of being adherent compared with mail order pharmacy users. Patients who had a PCP were 1.26 (95% CI = 1.18-1.34, P < 0.001) times more likely to be adherent to their medication.

Leveraging publicly available population data to create SDoH measures is an accessible option to overcome barriers to SDoH data collection. Derived measures can be used to increase equity in care received by identifying patients who could benefit from assistance with medication adherence.

Hypertension is one of the most common chronic diseases with a low control rate globally. The effect of communication skills training contributing to hypertension control remains uncertain. The aim of the present study was to assess the effectiveness of an educational intervention based on the Calgary-Cambridge guide in improving hypertensive management.

A cluster randomized controlled trial enrolled 27 general practitioners (GPs) and 540 uncontrolled hypertensive patients attending 6 community health centers in Chengdu, China. GPs allocated to the intervention group were trained by an online communication course and two face-to-face workshops based on Calgary-Cambridge guides. The primary outcome was blood pressure (BP) control rates and reductions in systolic and diastolic BP from baseline to 3 months. The secondary outcome was changes in GPs' communication skills after one month, patients' knowledge and satisfaction after 3 months. Bivariate analysis and the regression model assessed whether the health provider training improved outcomes.

After the communication training, the BP control rate was significantly higher (57.2% vs. 37.4%, p < 0.001) in the intervention groups. Compared to the control group, there was a significant improvement in GP's communication skills (13.0 vs 17.5, p < 0.001), hypertensive patients' knowledge (18.0 vs 20.0, p < 0.001), and systolic blood pressure (139.1 vs 134.7, p < 0.001) after 3 months of follow-up. Random effects least squares regression models showed significant interactions between the intervention group and time period in the change of GP's communication skills (Parameter Estimated (PE): 0.612, CI:0.310,0.907, p = 0.006), hypertensive patient's knowledge (PE:0.233, CI: 0.098, 0.514, p < 0.001), satisfaction (PE:0.495, CI: 0.116, 0.706, p = 0.004), SBP (PE:-0.803, CI: -1.327, -0.389, p < 0.001) and DBP (PE:-0.918, CI: -1.694, -0.634, p < 0.001), from baseline to follow-up.

Communication training based on the Calgary-Cambridge guide for GPs has shown to be an efficient way in the short term to improve patient-provider communication skills and hypertension outcomes among patients with uncontrolled BPs.

The trial was registered on Chinese Clinical Trials Registry on 2019-04-03. (ChiCTR1900022278).

Hypertension is a major risk factor for cardiovascular disease and the leading cause of death in Colombia. While the rate of hypertension awareness in Colombia is generally high, rates of treatment initiation, adherence, and blood pressure (BP) control are suboptimal. Major international hypertension guidelines recommend starting treatment with a combination of antihypertensive agents, and the use of a single-pill combination (SPC) to maximize adherence. In contrast, Colombian hypertension guidelines recommend starting treatment with diuretic monotherapy in most patients, and only initiating combination therapy in those with BP > 160/100 mmHg. Therefore, the aim of the current narrative review is to examine the rationale for using SPCs to treat hypertension in Colombia, in the context of the major issues for BP control there. There is evidence of widespread therapeutic inertia in hypertension management, particularly in primary care, in Colombia. Moreover, combination therapy, angiotensin-converting enzyme inhibitors, and long-acting calcium channel blockers, which are internationally recommended as first-line drug therapies, are underutilized there. Adherence to antihypertensive therapy is low in Colombia and may be enhanced by use of SPCs as well as better patient education and follow-up. While there are promising national initiatives to improve BP management, more needs to be done by individual physicians. Antihypertensive SPCs are available on the national essential medicines list and may help to overcome some of the problems with suboptimal adherence, therapeutic inertia, and low rates of BP control that contribute to the high cardiovascular death rate in Colombia.

This study investigates the relationship between young people's subjective health evaluations, self-care practices, and therapeutic networks using semi-structured interviews and the computerized qualitative thematic analysis capabilities of the MAXQDA software. In the summer of 2022, 41 Russian youths, ages 16 to 25, took part in this investigation. The major findings demonstrate that young people who had low health evaluations were more likely to conduct self-care with the intention of enhancing their health and to have mothers and other medical experts in their therapeutic networks. Furthermore, individuals who claimed that their health was inadequate engaged in more sports and took care of themselves even when they were ill. There was no association between the objectives of self-care practices, members of the therapeutic network, and self-care activities in terms of the type of health evaluation. Overall, it is possible to suggest that the practices and the structure of therapeutic networks are related to self-evaluated health, but quantitative study is needed to verify the causal relationship.

Research surrounding tumor boards has focused on patient outcomes and care coordination. Little is known about the patient experience with tumor boards. This survey examined aspects of the patient experience for patients presented at our multidisciplinary endocrine tumor board (ETB). A 15-item survey was distributed via the online patient portal to patients over the age of 18 whose case had been discussed at our ETB over an 18-month period. Descriptive statistics were reported, and a Fisher's exact test was used to examine relationships between variables. A total of 47 patients completed the survey (46%). A majority (72%) report their provider explained what the ETB is, and 77% report being informed their case would be discussed. Most patients were satisfied their case was being discussed (72%). A number of patients did report moderate or severe anxiety knowing their case was being discussed (15%). Sixty-four percent of patients report the ETB recommendations were clearly explained; however, satisfaction with the recommendations was slightly lower (53%). Despite the somewhat low satisfaction with the recommendations, 75% of patients felt more confident in their treatment plan knowing their case was discussed. Finally, if given the chance, 66% responded that they would have been interested in participating in their own ETB discussion. This study provides some insight into the patient experience surrounding tumor board discussions. Overall, patients are satisfied when their case is discussed at ETB. Patients can also experience anxiety about these discussions, and many patients desire to be present for their own discussions.

This convergent parallel-design mixed-methods process evaluation of the QUARTET USA (Quadruple Ultra-Low-Dose Treatment for Hypertension USA) clinical trial (NCT03640312) explores patient and health care professional perceptions about the use of low-dose quadruple therapy (LDQT) as a novel strategy for hypertension management.

A survey of all 62 patients enrolled in the QUARTET USA trial was conducted. A subsample of 13 patients and 11 health care professionals, recruited via purposive sampling, took part in semistructured interviews. At enrollment, 68% of participants (mean [SD] age, 51.7 [11.5] years; 56% self-identified as Hispanic: Mexican ethnicity, 16% as Hispanic: other ethnicity, 16% as Black race, 8% as White race, and 1.6% as South Asian race) reported that their current health depended on blood pressure medications, and 48% were concerned about blood pressure medications. At trial completion, 80% were satisfied with LDQT, 96% were certain the benefits of taking LDQT outweighed the disadvantages, and 96% reported that LDQT was convenient to take. Both patients and health care professionals found LDQT acceptable because it reduced patients' perceived pill burden and facilitated medication adherence. Health care professionals stated that a perceived limitation of LDQT was the inability to titrate doses. Steps to facilitate LDQT implementation include introducing stepped-care combinations and treatment protocols, inclusion in clinical practice guidelines, and eliminating patient cost barriers.

LDQT was an acceptable strategy for hypertension treatment among patients and health care professionals involved in the QUARTET USA clinical trial. Although LDQT was generally perceived as beneficial for maintaining patients' blood pressure control and facilitating adherence, some clinicians perceived limitations in titration inflexibility, adverse effects, and costs.

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03640312.

The Chronic Care Model (CCM) is a framework that supports the proactive, planned, coordinated and patient-centered care of chronic diseases. The Patient Assessment of Chronic Illness Care (PACIC) scale is a valuable tool for evaluating patients' perspectives on chronic care delivery based on the CCM. Few studies have examined its application in China. This study assesses hypertension care in Chinese patients and explores how PACIC scores relate to patient compliance. A cross-sectional study was conducted in Hangzhou, China, from June to August 2021, including 253 hypertensive patients from 5 county hospitals and 13 primary healthcare centers. The study used the PACIC scale to assess hypertension care delivery and the Compliance of Hypertensive Patients scale (CHPS) to measure patient compliance. Multiple linear regression analyses were used to explore the relationship between demographic characteristics and the total and domain scores of PACIC, as well as the association between CHPS and the domain scores of PACIC. The mean value of overall the PACIC score was 3.12 (out of 5). Problem solving/contextual domain had the highest average score for each item, while follow up/coordination domain had the lowest. Patient activation had negative effects on intention (β = -.18, P < .05), attitude (β = -.21, P < .05), responsibility (β = -.17, P < .05), and the total score of CHPS (β = -.24, P < .01). Delivery system design/decision support was negatively associated with lifestyle (β = -.21, P < .05) and the total score of CHPS (β = -.26, P < .01). Hypertensive patients perceived that they sometimes received hypertension care consistent with the CCM in Chinese primary healthcare settings. A higher level of PACIC score was beneficial for improving hypertensive patient compliance.

This study aims at exploring the effects of physicians' communication behaviors on patients' satisfaction in primary care medical consultations in Chattogram, Bangladesh. The study used a quantitative research approach designed with a cross-sectional survey.

Data were collected using post-consultation and facilitator administered questionnaire from the patients who visited the physician for medical consultation in different hospitals and clinics in Chattogram city. Seven hundred patients were included as the study participants. A hierarchical linear regression analysis was performed to examine the factors contributing to the outcome variables.

A statistically significant difference (P < .001) appeared regarding patients' perception of adequate consultation, physicians' nonverbal behavior, inhibiting behavior and patients' participating behavior in private and public settings. However, R2 value shows that physicians' patient-centered behaviors appeared as the stronger predictors of patient satisfaction toward medical interviews, followed by socioeconomic variables of patients and physicians and patients' participation during the consultation. Presence of a third person with patients during consultation (β = -.05, P = .040), physicians' private setting of consultation (β = .16, P < .001), physicians' seniority (β = .05, P = .042), patients' participating behavior during consultation (β = .20, P < .001), physicians' nonverbal behavior (β = .10, P < .001), physicians' inhibiting behavior (β = -.39, P < .001), and physicians' facilitating behavior with patients (β = .32, P < .001) were reported as the influencing factors of patients' satisfaction with medical consultation.

This study suggests the profound impact of physicians' patient-centered communication behaviors on patient satisfaction in primary care settings, overshadowing even socioeconomic factors and patient participation.

We conducted a systematic scoping review of self-report tools used to measure patient and/or caregiver satisfaction with clinician communication. Aims included identifying: 1) instruments that have been used to measure communication satisfaction, and 2) content of the communication items on measures.

Two databases (PubMed and CINAHL) were searched for relevant studies. Eligibility included patient or caregiver self-report tools assessing satisfaction with clinicians' communication in a biomedical healthcare setting; and the stated purpose for using the measurement involved evaluating communication satisfaction and measures included more than one question about this. All data were charted in a form created by the authors.

Our search yielded a total of 4531 results screened as title and abstracts; 228 studies were screened in full text and 85 studies were included in the review. We found 53 different tools used to measure communication satisfaction among those 85 studies, including 29 previously used measures (e.g., FS-ICU-24, CAHPS), and 24 original measures developed by authors. Content of communication satisfaction items included satisfaction with content-specific communication, interpersonal communication skills of clinicians, communicating to set the right environment, and global communication satisfaction items.

There was high variability in the number of items and types of content on measures. Communication satisfaction should be better conceptualized to improve measurement, and more robust measures should be created to capture complex factors of communication satisfaction.

Creating a rigorous evaluation of satisfaction with clinician communication may help strengthen communication research and the assessment of communication interventions.

This systematic review aims to explore the association between abusive behaviour and physician-patient relations in healthcare settings.

Systematic review.

We searched for related studies on databases such as PubMed, Embase, and the Cochrane library, without restrictions on language, from inception until July 15, 2022. The risk of bias and the methodological quality was evaluated using the Newcastle-Ottawa Scale and Risk of Bias in Non-randomised Studies of Interventions tool.

Ten studies were included in this systematic review, the participants of which were physicians and patients. The research from all the studies highlighted the detrimental effects of abusive behaviour on the relationship between physicians and patients, regardless of who the abusers were.

Abusive behaviour in a clinical setting has a negative influence on the physician-patient relationship, whoever the perpetrator might be. The research sheds light on the importance of teaching communication skills to physicians and training them to manage conflicts and aggressive behaviours in healthcare settings.

Shared decision-making is increasingly embraced in health care and recommended in cardiovascular guidelines. Patient involvement in health care decisions, patient-clinician communication, and models of patient-centered care are critical to improve health outcomes and to promote equity, but formal models and evaluation in cardiovascular care are nascent. Shared decision-making promotes equity by involving clinicians and patients, sharing the best available evidence, and recognizing the needs, values, and experiences of individuals and their families when faced with the task of making decisions. Broad endorsement of shared decision-making as a critical component of high-quality, value-based care has raised our awareness, although uptake in clinical practice remains suboptimal for a range of patient, clinician, and system issues. Strategies effective in promoting shared decision-making include educating clinicians on communication techniques, engaging multidisciplinary medical teams, incorporating trained decision coaches, and using tools (ie, patient decision aids) at appropriate literacy and numeracy levels to support patients in their cardiovascular decisions. This scientific statement shines a light on the limited but growing body of evidence of the impact of shared decision-making on cardiovascular outcomes and the potential of shared decision-making as a driver of health equity so that everyone has just opportunities. Multilevel solutions must align to address challenges in policies and reimbursement, system-level leadership and infrastructure, clinician training, access to decision aids, and patient engagement to fully support patients and clinicians to engage in the shared decision-making process and to drive equity and improvement in cardiovascular outcomes.

The clinical and economic burden of hypertension is high and continues to increase globally. Uncontrolled hypertension has severe but avoidable long-term consequences, including cardiovascular diseases, which are among the most burdensome and most preventable conditions in Europe. Yet, despite clear guidelines on screening, diagnosis and management of hypertension, a large proportion of patients remain undiagnosed or undertreated. Low adherence and persistence are common, exacerbating the issue of poor blood pressure (BP) control. Although current guidelines provide clear direction, implementation is hampered by barriers at the patient-, physician- and healthcare system levels. Underestimation of the impact of uncontrolled hypertension and limited health literacy lead to low adherence and persistence among patients, treatment inertia among physicians and a lack of decisive healthcare system action. Many options to improve BP control are available or under investigation. Patients would benefit from targeted health education, improved BP measurement, individualized treatment or simplified treatment regimens through single-pill combinations. For physicians, increasing awareness of the burden of hypertension, as well as offering training on monitoring and optimal management and provision of the necessary time to collaboratively engage with patients would be useful. Healthcare systems should establish nationwide strategies for hypertension screening and management. Furthermore, there is an unmet need to implement more comprehensive BP measurements to optimize management. In conclusion, an integrative, patient-focused, multimodal multidisciplinary approach to the management of hypertension by clinicians, payers and policymakers, involving patients, is required to achieve long-term improvements in population health and cost-efficiency for healthcare systems.

Effective communication is a cornerstone of quality healthcare. Communication helps providers bond with patients, forming therapeutic relationships that benefit patient-centred outcomes. The information exchanged between the provider and patient can help in medical decision-making, such as better self-management. This rapid review investigated the effects of quality and effective communication on patient-centred outcomes among older patients.

Google Scholar, PubMed, Scopus, CINAHL, and PsycINFO were searched using keywords like "effective communication," "elderly," and "well-being." Studies published between 2000 and 2023 describing or investigating communication strategies between older patients (65 years and above) and providers in various healthcare settings were considered for selection. The quality of selected studies was assessed using the GRADE Tool.

The search strategy yielded seven studies. Five studies were qualitative (two phenomenological study, one ethnography, and two grounded theory studies), one was a cross-sectional observational study, and one was an experimental study. The studies investigated the effects of verbal and nonverbal communication strategies between patients and providers on various patient-centred outcomes, such as patient satisfaction, quality of care, quality of life, and physical and mental health. All the studies reported that various verbal and non-verbal communication strategies positively impacted all patient-centred outcomes.

Although the selected studies supported the positive impact of effective communication with older adults on patient-centred outcomes, they had various methodological setbacks that need to be bridged in the future. Future studies should utilize experimental approaches, generalizable samples, and specific effect size estimates.

Peripheral neuropathy is a neurological disorder characterised by pain, numbness, or tingling due to nerve damage. Peripheral neuropathy is one of the main health issues in Kuwait and is a rising concern which affects a large proportion of the population, therefore the lived experience needs to be explored to identify areas for improvement in care. This qualitative study explored the experiences of people living with peripheral neuropathy in Kuwait.

Semi-structured interviews were conducted with 25 participants recruited from the Neurology Outpatient Clinic of the Ibn Sina Hospital in Kuwait. The interview questions explored their experiences and understanding of pain along with the impact on their daily life. The interviews were audio recorded, transcribed and translated into English then coded using NVivo 12. Thematic analysis was conducted to identify patterns and themes in the data.

Three major themes were identified including treatment beliefs (perceived effectiveness of treatment and seeking alternative treatments), the barriers to pain management (medication side effects, relationships with healthcare professionals and lack of information and access to healthcare), and the impact on quality of life (impact on work and social, physical, and psychological consequences). Self-efficacy was a key construct and over-arching theme that was discussed in all aspects, which finds reflection in the protection motivation theory.

This paper presents the experiences of people living with peripheral neuropathy and highlights there is scope for improvement of current treatments in Kuwait. Self-management strategies are recommended alongside prescribed medication and healthcare professionals are encouraged to use a patient-centered approach. More importantly, information and support on the condition to promote coping strategies and self-efficacy should be adopted to improve quality of life. These findings can be implemented locally and globally to improve the quality of care provided to people living with peripheral neuropathy.

Adhering to clinical prescriptions is known to protect against the effects of uncontrolled hypertension and of acute and chronic cardiovascular diseases, including diabetes. Contextually, positive associations between self-care behaviors and psychological constructs, such as self-efficacy, are widely acknowledged in the literature. However, still little is known about the psychological factors underlying the patient's self-efficacy. This study aimed to investigate the psychosocial and behavioral correlates of self-efficacy related to treatment adherence in older patients with comorbid hypertension and type 2 diabetes mellitus.

Italian and Polish patients (≥ 65 years; N = 180) consecutively responded to self-report questionnaires measuring psychosocial (i.e., beliefs about medicines, perceived physician's communication effectiveness, medication-specific social support, self-efficacy) and behavioral factors (i.e., pharmacological adherence, medications refill adherence, intentional non-adherence) related to treatment adherence. Between-group comparisons and regression analyses were performed.

Fisher's least significant difference (LSD) test showed significant differences between the Italian and Polish groups in all questionnaires (p < .01) with the Italian patients reporting more satisfactory scores. Younger age (β = .08, p = .045), female gender (β = 1.03, p = .042), higher medication refills adherence (β = -.07, p = .024), lower intentional non-adherence (β = -.03, p = .009), positive beliefs about medications (β = .13, p < .001), better quality of communication with the physician (β = .09, p < .001), and stronger perceived medication-specific social support (β = .06, p = .001) were significantly associated with self-efficacy related to treatment adherence.

Future research and interventions should leverage psychosocial and behavioral factors to address self-efficacy contributing to enhancing adherence to clinical prescriptions.

Risk-reducing bilateral salpingo-oophorectomy (RRSO) is an effective prophylactic surgery provided to premenopausal women carrying BRCA1 or BRCA2 mutations and presenting an increased risk of developing breast or ovarian cancer. This procedure is related to physiological, sexual, and psychosocial distress, which altogether increase uncertainty and complexity in the clinical decision-making process and post-surgery adaptation. Physician-patient communication (PPC) has been pointed out as a determinant factor in the decision-making to undergo RRSO, and the subsequent adjustment of women. However, studies examining the psychosocial impact of the decision-making process have been scarce and often lack clear theoretical frameworks. While the role of PPC in such processes has been highlighted in a few qualitative studies, there is a paucity of quantitative research addressing this question. Therefore, this narrative review, conducted using a multidisciplinary approach, was planned to: (1) present an updated medical background for RRSO; (2) analyze the psychosocial impact of the decision-making process within a theoretical framework of the Health Belief Model; and (3) discuss the role of PPC in such a decision-making process and in post-surgery. The collected research also enabled the recommendation of some additions to the existing clinical guidelines and the outlining of future research directions.

Patient education of high-risk medications such as direct oral anticoagulants (DOACs) is limited in ambulatory care settings. Clinical pharmacists are uniquely equipped to educate patients about DOACS but seldom interact with patients in those settings where patient education and satisfaction are often overlooked. Recently, the Anticoagulation Forum endorsed a checklist (DOAC Checklist) to guide and educate patients initiating or resuming DOACs. We assessed the impact on knowledge and satisfaction of an intervention framed around the checklist. Randomized clinical trial. Ambulatory patients starting a DOAC or resuming one after setback (bleeding, stroke, or transient ischemic attack) in an ambulatory setting (office, emergency department, or short stay hospitalization). Three educational clinical pharmacist tele-visits, hotline access to the pharmacist, and coordination with continuity providers in 3 months. Patient knowledge scores from a 15-item DOAC-related questionnaire and satisfaction scores from an abbreviated version of the Duke Anticoagulation Satisfaction Survey (DASS). Of 561 randomized patients, 436 completed our follow-up surveys. Knowledge scores were similar for the 233 intervention patients vs. 203 control patients (63.7% vs 62.2% correct). Satisfaction scores on the 7-point Likert scale were virtually identical (6.24 and 6.22). Our pharmacist-led intervention framed around the DOAC checklist had little impact on knowledge and satisfaction. Delays between intervention end and completion of the follow-up questionnaires may have obscured benefits experienced earlier. More intensive education or strategies other than telephone-based consultation may be required to produce sustained knowledge.TRN: NCT04068727 retrospectively registered on August 22, 2019.

Hypertension is a growing public health concern worldwide. It is a leading risk factor for all-cause mortality and may lead to complications such as cardiovascular disease, stroke, and kidney failure. Poor compliance of hypertensive patients is one of the major barriers to controlling high blood pressure. Compliance is not ideal among Chinese patients, and increasing patient self-care compliance with hypertension is necessary.

This article analyzes the status of self-care compliance, trust, and satisfaction among Chinese hypertensive patients using cross-sectional data from Zhejiang Province. We use a multi-group structural equation model (MGSEM) to compare the interrelationships across genders.

The study's findings show that the average trust, satisfaction, and compliance scores are 3.92 ± 0.55, 3.98 ± 0.61, and 3.33 ± 0.41, respectively. Female patients exhibit higher average total scores for trust and compliance than male patients. The SEM results indicate that trust has a direct positive association with compliance [β = 0.242, 95% CI: (0.068, 0.402)] and satisfaction [β = 0.260, 95% CI: (0.145, 0.367)], while their satisfaction is not directly associated with compliance. The results of MGSEM show that trust has an indirect effect on compliance in the male group through satisfaction [β = 0.051, P < 0.05, 95% CI: (0.012, 0.116)]. In the female group, trust has a direct effect on satisfaction [β = 0.235, P < 0.05, 95% CI: (0.041, 0.406)] and compliance [β = 0.319, P < 0.01, 95% CI: (0.086, 0.574)].

This study reveals the mechanisms of self-care compliance, trust, and satisfaction among Chinese hypertensive patients. Its findings may serve as a reference for guiding primary healthcare providers to improve hypertension patients' compliance and implement gender-targeted health interventions.

Implementation research to improve hypertension control is scarce in Latin America. We assessed the effectiveness of an intervention aimed at primary care practitioners and hypertensive patients in a setting that provides integrated care through an accessible network of family practices.

We conducted in Cardenas and Santiago, Cuba, a controlled before-after study in 122 family practices, which are staffed with a doctor and a nurse. The intervention comprised a control arm (usual care), an arm with a component targeting providers (hypertension management workshops), and an arm with, on top of the latter, a component targeting patients (hypertension schools). To evaluate the effect, we undertook a baseline survey before the intervention and an endline survey sixteen months after its start. In each survey, we randomly included 1400 hypertensive patients. Controlled hypertension, defined as a mean systolic and diastolic blood pressure below 140 and 90 mmHg, respectively, was the primary endpoint assessed. We performed linear and logistic regression with a Generalized Estimating Equations approach to determine if the proportion of patients with controlled hypertension changed following the intervention.

Seventy-three doctors, including substitutes, and 54 nurses from the 61 intervention family practices attended the provider workshops, and 3308 patients -51.6% of the eligible ones- participated in the hypertension schools. Adherence to anti-hypertensive medication improved from 42% at baseline to 63% at the endline in the intervention arms. Under the provider intervention, the proportion of patients with controlled hypertension increased by 18.9%, from 48.7% at baseline to 67.6% at endline. However, adding the component that targeted hypertensive patients did not augment the effect. Compared to patients in the control arm, the adjusted OR of having controlled hypertension was 2.36 (95% CI, 1.73-3.22) in the provider and 2.00 (95% CI, 1.68-2.37) in the provider plus patient intervention arm.

The intervention's patient component remains to be fine-tuned. Still, we demonstrate that it is feasible to substantially improve hypertension outcomes by intervention at the primary care level, despite an already relatively high control rate.

An important gap in the literature is how clinicians feel about patient-centered technologies and how clinicians experience patient-centered technologies in their workflows. Our goal was to identify clinician users' perspectives on facilitators (pros) and barriers (cons) to using 1 digital texting innovation to promote family centered care during patients' hospitalizations. This qualitative study was conducted at a tertiary care center in Houston, consisting of 7 hospitals (1 academic hospital and 6 community hospitals), involving analyzation of 3 focus groups of 18 physicians, 5 advanced practice providers, and 10 nurse directors and managers, as well as a content analysis of 156 real-time alerts signaling family dissatisfaction on the nursing unit/floor. Thematic analysis methods were used. We selected these participants by attending their regularly scheduled service-line meetings. Clinician feedback from focus groups resulted in 3 themes as facilitators: (a) texting platforms must be integrated within the electronic medical record; (b) texting reduces outgoing phone calls; (c) texting reduces incoming family phone calls. Clinician feedback resulted in 3 themes as barriers: (a) best practice alerts can be disruptive; (b) real-time alerts can create hopelessness; and (c) scale-up is challenging. The analyzation of facilitators (pros) and barriers (cons) pertains only to the clinician's feedback. We also analyzed real-time alerts signaling family dissatisfaction (defined as "service recovery escalation" throughout this manuscript). The most common selection for the source of family dissatisfaction, as reflected through the real-time alerts was, "I haven't heard from physicians enough," appearing in 52 out of 156 alerts (33%). The second most common selection for the source of dissatisfaction was "perceived inconsistent or incomplete information provided by team members," which was selected in 48 cases (31%). Our findings indicate that clinicians value inpatient texting, not only for its ability to quickly relay updates to multiple family members with 1 click, but also because, when used intentionally and meaningfully, texting decreases family phone calls.