BACKGROUND: Good patient understanding of basic medication-related information such as directions for use and side effects promotes medication adherence, but information is lacking about how well patients understand basic medication-related information after their office visits. OBJECTIVE: The purpose of this study is to investigate post-visit patient understanding about newly prescribed medications. DESIGN: Secondary mixed methods analysis comparing patient survey responses about newly prescribed medications to information conveyed by physicians during office visits (from audio recordings of office visits). PARTICIPANTS: Eighty-one patients aged 50 and older who discussed newly prescribed medications during an outpatient office visit. MAIN MEASURES: Accurate patient identification of medication dose, number of pills, frequency of use, duration of use, and potential side effects. KEY RESULTS: The 81 patients in this study received 111 newly prescribed medications. For over 70% of all newly prescribed medications, patients correctly identified the number of pills, frequency of use, duration of use, and dose, regardless of whether the physician mentioned the information during the office visit. However, for 34 of 62 medications (55%) for which side effects were not conveyed and 11 of 49 medications (22%) for which physicians discussed side effects, patients reported that the medication lacked side effects. Analysis of transcribed office visits showed that potential reasons for this finding included failure of physicians to mention or to use the term side effects during visits, the prescription of multiple medications during the visit, and lack of patient engagement in the conversation. CONCLUSIONS: Many patients correctly identified information related to directions for taking a newly prescribed medication, even without physician counseling, but when physicians failed to convey potential medication side effects, many assumed that a medication had no side effects. It may be sufficient for physicians to provide written information about medication directions and dosing, and tailor their limited time to discussing medication side effects.

BACKGROUND: Telemedicine can be used to manage various health conditions, but there is a need to investigate its effectiveness for chronic disease management in the primary care setting. This study compares the effect of synchronous telemedicine versus in-person primary care visits on patient clinical outcomes. METHODS: A systematic review of studies published in PubMed and Web of Science between 1996 and January 2021 was performed using keywords related to telemedicine, diabetes, hypertension, and hyperlipidemia. Included studies compared synchronous telemedicine versus in-person visits with a primary care clinician, and examined outcomes of hemoglobin A1c (HbA1c), blood pressure, and/or lipid levels. RESULTS: Of 1724 citations screened, 7 publications met our inclusion criteria. Included studies were published between 2000 and 2018. Three studies were conducted in the United States, 2 in Spain, 1 in Sweden, and 1 in the United Kingdom. The telemedicine interventions investigated were multifaceted. All included synchronous visits with a primary care provider through videoconferencing and/or telephone, combined with other components such as asynchronous patient data transmission. Five studies reported on HbA1c changes, 5 on blood pressure changes, and 3 on changes in lipid levels. Compared to usual care with in-person visits, telemedicine was associated with greater reductions in HbA1c at 6 months and similar HbA1c outcomes at 12 months. Telemedicine conferred no significant differences in blood pressure and lipid levels compared to in-person clinic visits. CONCLUSIONS: A systematic review of the literature found few studies comparing clinical outcomes resulting from synchronous telemedicine versus in-person office visits, but the existing literature showed that in the primary care setting, telemedicine was not inferior to in-person visits for the management of diabetes, hypertension, or hypercholesterolemia. These results hold promise for continued use of telemedicine for chronic disease management.

Patients infrequently disclose use of dietary supplements to providers. Little is known about factors that motivate patients to disclose supplement use. The study aimed to identify reported factors motivating patients' disclosure and nondisclosure of dietary supplement use and explore differences based on type of supplement and provider practice. Mixed methods study combining qualitative content analysis of semi-structured interviews with statistical analyses to assess differences in identified factors by provider practice type and supplement type. Seventy-eight English-speaking patients who reported taking 466 dietary supplements in the previous 30 days were recruited from primary care and Complementary and Alternative Medicine (CAM), and Integrative Medicine (IM) offices in Southern California. We identified nine themes related to disclosure and nine related to nondisclosure of dietary supplement use. Major themes were features of the office visit, circumstances in patient health and medical care, and provider/patient characteristics. The most commonly raised theme promoting disclosure of supplement use was provider inquiry. Patients associate disclosure with having concerns about a supplement but also with annual physical exams and some routine topics of discussion, including self-care, lab results, and new medication prescriptions. Themes related to nondisclosure included lack of provider inquiry, features of the office visit, such as supplements being unrelated to the visit purpose, and patients' convictions that supplements are safe or not important to discuss. Themes did not vary by supplement type. Primary care patients were more likely than CAM/IM patients to attribute nondisclosure to convictions that supplements were beneficial, not worth mentioning, or equivalent to food (p ≤ 0.001). When providers fail to ask directly about dietary supplement use, disclosure is often an impromptu decision that is driven by the content of provider-patient interactions. Ensuring disclosure of dietary supplement use to prevent potential drug-supplement interactions or adverse health outcomes likely requires consistent, proactive provider queries about supplement use.

Objectives

Timely multidisciplinary family meetings (TMFMs) promote shared decision-making. Despite guidelines that recommend meetings for all patients with serious illness, our NICU TMFM rate was 10%. In this study, we aimed to document a meeting within 5 days of hospitalization for 50% of all new NICU patients hospitalized for ≥5 days within 1 year of introducing interventions.

Methods

A multidisciplinary improvement team used the Model for Improvement to achieve the study aim by targeting key drivers of change. To make meetings easier, we introduced scheduling and documentation tools. To make meetings more customary, we provided education and reminders to professionals. We defined a TMFM as a documented discussion between a parent, a neonatologist, and a nonphysician professional, such as a nurse, within 5 days of hospitalization. We used statistical process control charts to assess the monthly proportion of new patients with a TMFM. In surveys and feedback sessions, family and clinician satisfaction with communication was assessed.

Results

TMFM documentation tripled during the intervention year when compared with the previous year (28 of 267 [10.5%] vs 70 of 224 [31.3%]; P < .001), revealing evidence of special cause variation on the statistical process control chart. Clinicians predominantly used ad hoc documentation instead of our scheduling and documentation tools. Parental satisfaction with care and communication did not vary significantly after interventions. Most physicians reported satisfaction with meetings. Nurses reported feeling empowered to request meetings.

Conclusions

An academic, quaternary-care NICU tripled TMFM documentation after introducing a multifaceted intervention. This improvement may represent changes in professionals' attitudes about providing and documenting family meetings.

Background

Little is known about how providers communicate recommendations when scientific uncertainty exists.

Objectives

To compare provider recommendations to those in the scientific literature, with a focus on whether uncertainty was communicated.

Design

Qualitative (inductive systematic content analysis) and quantitative analysis of previously collected audio-recorded provider-patient office visits.

Participants

Sixty-one providers and a socio-economically diverse convenience sample of 603 of their patients from outpatient community- and academic-based primary care, integrative medicine, and complementary and alternative medicine provider offices in Southern California.

Main measures

Comparison of provider information-giving about vitamin D to professional guidelines and scientific information for which conflicting recommendations or insufficient scientific evidence exists; certainty with which information was conveyed.

Results

Ninety-two (15.3 %) of 603 visit discussions touched upon issues related to vitamin D testing, management and benefits. Vitamin D deficiency screening was discussed with 23 (25 %) patients, the definition of vitamin D deficiency with 21 (22.8 %), the optimal range for vitamin D levels with 26 (28.3 %), vitamin D supplementation dosing with 50 (54.3 %), and benefits of supplementation with 46 (50 %). For each of the professional guidelines/scientific information examined, providers conveyed information that deviated from professional guidelines and the existing scientific evidence. Of 166 statements made about vitamin D in this study, providers conveyed 160 (96.4 %) with certainty, without mention of any equivocal or contradictory evidence in the scientific literature. No uncertainty was mentioned when vitamin D dosing was discussed, even when recommended dosing was higher than guideline recommendations.

Conclusions and relevance

Providers convey the vast majority of information and recommendations about vitamin D with certainty, even though the scientific literature contains inconsistent recommendations and declarations of inadequate evidence. Not communicating uncertainty blurs the contrast between evidence-based recommendations and those without evidence. Providers should explore best practices for involving patients in decision-making by acknowledging the uncertainty behind their recommendations.

AbstractBackgroundThis study examines the psychometric properties of 9 items on the Patient Activation component of the Medicare Current Beneficiary Survey (MCBS) that assess how patients approach and communicate with their physicians. The MCBS is a nationally representative, cross-sectional survey of Medicare beneficiaries.MethodsWe analyzed MCBS data collected in 2002 and 2005 from 15,165 adults aged 65 and older. Exploratory factor analysis was conducted using maximum likelihood to estimate a polychoric correlation matrix on the 2002 data, and confirmatory factor analysis was performed using the 2005 data.ResultsExploratory factor analysis of the 2002 data showed a 2-factor solution: approach to interactions (5 items) and views about physician’s healthcare communication (6 items). Findings were confirmed using the 2005 data. Items were combined to form the Patient Approach and Views toward Healthcare Communication (PAV-COM) scale (range 1 to 100; Cronbach’s alpha of 0.75, and item-rest correlations between 0.33 and 0.54). Higher PAV-COM scores were associated with greater fulfillment of preventive health behaviors such as vaccinations and cancer screenings.ConclusionsThe PAV-COM measure is a valid tool for assessing patient approaches and views toward communication with physicians. This measure can be used to evaluate interventions to improve patient participation during healthcare encounters.

Background

Medications for alcohol use disorder (MAUD) are underutilized in mental health settings. Increasing use of MAUD requires increasing both the availability of these medications and the demand by individuals who could benefit. Few studies have explored the views of individuals with severe mental illness and alcohol use disorder about MAUD. We sought to examine, among individuals treated in publicly funded community mental health clinics, perceived need for and attitudes toward MAUD.

Methods

We conducted 8 focus groups with 87 participants treated in public mental health clinics in Los Angeles County. We aimed to include individuals with a current or past AUD diagnosis and individuals helping others (e.g., a family member) who drink. We examined responses using domains associated with the Health Belief Model to identify factors that shape acceptance of MAUD.

Results

Participants were 53% female; most were minorities. Average age was 47 years (SD = 11). Twenty-four reported never drinking, 13 of whom had a current or past diagnosis of AUD. Twenty-two reported drinking 4 or more times per week. Three-quarters had not heard of naltrexone. Participants understood that alcohol use has severe adverse consequences and perceived themselves to be highly susceptible to these consequences. Regarding attitudes toward MAUD, participants described an internal locus of control (e.g., their own desires, actions, and effort) as central to addressing problem drinking; this shaped their views that MAUD would have only modest benefits and potentially high burden. Those individuals who had tried MAUD expressed the most optimism about its effectiveness.

Conclusions

Participants worried MAUD would impede the development of self-control over drinking by fostering dependence on medication and undermining self-discipline. Client education and counseling that emphasizes MAUD as a tool to build clients' self-control may increase demand for these medications in mental health settings.