This study explored patients' experiences of participation and non-participation in their health care. A questionnaire-based survey method was used. Content analysis showed that conditions for patient participation occurred when information was provided not by using standard procedures but based on individual needs and accompanied by explanations, when the patient was regarded as an individual, when the patient's knowledge was recognized by staff, and when the patient made decisions based on knowledge and needs, or performed self-care. Thus, to provide conditions for true patient participation, professionals need to recognize each patient's unique knowledge and respect the individual's description of his or her situation rather than just inviting the person to participate in decision making.
The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.
The goal of total hip arthroplasty (THA) is optimal pain relief and a normalized health-related quality of life. Anxious patients describe more pain and more difficulties than non-anxious patients during rehabilitation after THA. The aims of the present study were twofold: (1) to identify vulnerable patients using the general self-efficacy scale (GSES) and the Tampa scale for Kinesiophobia (TSK), and (2) to evaluate if person-centred care including the responses of the instruments made rehabilitation more effective in terms of shortening hospital length of stay.The design of the study was quasi-experimental. Patients scheduled for THA, a control group (n = 138) and an intervention group (n = 128) were consecutively recruited. The intervention was the provision of person-centred care which was designed to reduce the negative effects of low self-efficacy and high levels of pain-related fear of movement.Patients with low GSES in the intervention group had shorter length of stay (LoS) by 1.6 days (95 % CI 0.16-3.15) p-value 0.03. Patients with high TSK in the intervention group had shorter LoS by 2.43 days (95 % CI 0.76-4.12) p-value 0.005. For patients who had both, the reduction of LoS was 2.15 days (95 % CI 0.24-4.04) p-value 0.028.The GSES and the TSK instrument were found useful as tools to provide information to support patients which reduced the LoS by 1.67 days in the whole intervention group (95 % CI 0.72-2.62) p-value 0.001. More importantly, vulnerable patients such as ASA group 3 probably gained the most from the extra support, they had a reduction with 6.78 days (95 % CI 2.94-10.62) p-value 0.001.
Axel Wolf and colleagues discuss an initiative in Sweden that is redesigning healthcare in partnership with patients and achieving better clinical outcomes
Background and Research Objective: Despite the known benefit of self-care strategies for symptom management in heart failure (HF), most patients are unable to perform self-care activities successfully. This study therefore examined how communication about the HF regimen between patients and their physicians is experienced and understood by both partners. Subjects and Methods: Six pairs (n = 12) of adult patients with HF who were admitted for acute symptom exacerbation and their physicians were interviewed for this qualitative descriptive study in the inpatient setting. Semistructured in-depth interviews were conducted. Data were analyzed using content analysis. Results: Both patients and providers described adherence to the HF regimen as "work." Both reported the same list of tasks and knowledge requirements as key components of the HF regimen, and both reported delegating their own regimen-related work to others. Despite these similarities, perceptions of the nature and complexity of the work of the HF regimen differed. Patients described the regimen as "hard work," but physicians perceived patients as nonparticipatory in self-care, in spite of the instructions being "easy." Patients perceived themselves as understanding what to do but needing help with how to carry out self-care. By contrast, physicians perceived patients as not understanding what the regimen requires and therefore needing more repetition of knowledge-based instructions. Conclusion: The self-care regimen in chronic HF is characterized by both patients and physicians as work, but patient-physician dyads show divergent understandings of that work. Future research to improve adherence should move beyond the patient to look at the nature of the work itself and the relationship of the patient and caregivers to the work.
