Monday, 29 November 2021

Initiatives to define a patient-centred research agenda

Gloria Gálvez

By Society of Hospital Medicine
Despite the strong impact that the results of clinical research have on the health and quality of life of patients, the contributions they make remain anecdotal and do not go beyond participating as passive subjects in clinical trials. This, together with the practice of opportunistic strategies such as calling patients at the last moment to give their impressions of their participation, makes it necessary to move towards a new model of biomedical research in which, in addition to carrying out pharmacological studies, it seeks to respond to unresolved questions that would undoubtedly improve the patient experience.

In this sense, the James Lind Alliance initiative stands out; here patients, caregivers and professionals prioritize unresolved questions about the effects produced by some treatments so that the organizations that finance the research can discover the problems that people value most. Along the same lines, the Patient-Centered Outcomes Research Institute (PCORI) has worked and shared standards to formulate patient-centred clinical research questions. The methodology used can be found in the article recently published in the journal BMJ.

More recently, the American Society for Hospital Medicine committee, which serves to improve hospital outcomes through patient engagement (i-Hope), has collaborated with patients and other stakeholders to create a research agenda focused on the patient. Based on the methodology of PCORI and the James Lind Alliance, Harrison and colleagues have published a study in which patients, family members and other stakeholders have drawn up a list of research topics that they consider priorities to improve the care of hospitalized patients. At the same time, they have created a network of collaborators to advise, review and participate in future research that responds to these priorities.

The steering committee that oversaw this work, made up of patients in collaboration with health professionals and researchers, also invited other patients and interest groups to answer a questionnaire that would allow prioritizing the three main aspects to be answered to improve care hospitably.

Eleven research questions were selected, classified in order of importance, which can be consulted at this link or in this list:

  1. What actions ensure shared decision-making?
  2. What are the most effective practices for the transition between the hospital and other assistive devices after discharge?
  3. How can the healthcare team better educate on drug use and medical conditions to reduce possible errors during hospital care and in coordination at discharge?
  4. What do patients understand by a collaborative discharge process that empowers them and allows them to effectively manage their health once they are at home?
  5. How can patients identify and overcome barriers to understanding the information provided during hospitalization and at discharge?
  6. Can telemedicine be used to decrease readmissions or to improve transition in inpatient care?
  7. Who should the patient call after discharge if she has questions, concerns, or needs to contact the appropriate resources?
  8. How can patients and professionals collaborate effectively so that information related to diagnosis, testing and treatment after discharge is understandable?
  9. What are the patient's expectations regarding pain management?
  10. What are the best interventions to optimize treatment across the entire patient care?
  11. Would be providing clearer and more accessible information on hospital routines, such as parking, cafeteria or protocols for entering rooms, would it mean a better experience for the patient compared to normal practices?

If we analyze the questions considered as priorities by the respondents, three main themes stand out:

a) Patients and caregivers wish to participate in the shared decision making. An issue that worries us all and that presents important areas for improvement also in the larger clinical services with more workload.

b) Patients want to have a reference professional whom they can contact if problems or doubts arise after discharge or during the transition between the different healthcare devices.

c) Lastly, patients warn us that providing them with educational material without a complementary and adequate explanation from the health team does not by itself improve their understanding of the care they have to follow.

From this study, the scientific community and health professionals will be able to focus research questions on everything that matters most to patients. On the other hand, those responsible for health policies, as well as funding agencies, will be able to use the results of this study to promote more appropriate improvements that favour a better patient experience.

Monday, 22 November 2021

Humanism and literature in every area of healthcare

Marco Inzitari

Oliver Sack
Luckily, the person is regaining a central role in health care and his/hers perceptions, experiences and values are gaining importance at all levels: care, research and management. This is especially important in addressing the complex health and social issues with which we are increasingly surrounded.

Monday, 15 November 2021

Why is the integration of services not encouraged?

Jordi Varela



Health and social services are fragmented between various institutions, levels of care and a lot of specialities and each one of the fractions of the system provides a service that makes sense in itself, such as a three-hour weekly service of a family worker for lending a hand at the home of an elderly person who lives alone, or angioplasty intervention for a woman who has just suffered a myocardial infarction and, according to this system, funders pay differently for each activity.

Monday, 8 November 2021

A new recipe for teamwork in primary care

Jordi Varela


Primary care teams in Spain are under pressure from the schedules of daily visits, which sends multidisciplinary teamwork to the background. To understand each other, the sessions are held whenever possible and the level of attendance and participation is often irregular, given that nothing encourages them. The core aspect of a primary care centre today is that each doctor and each nurse is assigned a contingent of citizens -presumed to be patients-, who, when requested, must be attended to as soon as possible.

Monday, 1 November 2021

Empathy training

Andrés Fontalba

Communication is the most important skill for healthcare professionals. Efficient communication occurs when the therapist feels sure that he or she has listened to and registered the user's needs and, thanks to this, can provide personalized attention. Empathy is the ability to perceive, understand and share the feelings, thoughts and emotions of others, based on the recognition of the other as a person similar to ourselves, with a mind of their own. Both parties benefit from this empathy, and patients who experience empathy during their treatment obtain better results and greater chances of recovery. In turn, professionals with higher levels of empathy work more efficiently and productively and express greater satisfaction with their professional development.

Monday, 25 October 2021

How to inform, persuade and remind about COVID-19 vaccination

Pedro Rey


After a year in which the fight to control the transmission of COVID-19 has set the agenda, the debate is now focused on how to get a sufficient percentage of the population vaccinated to achieve the so-called "group immunity" as soon as possible. The objective now goes to the supply side: it is about establishing the sequence in which different population groups should be vaccinated (and with which vaccine each one) and making sure that the prioritization is fulfilled. We must also resolve as soon as possible how to eliminate bureaucratic obstacles so that vaccines are more easily accessible, more operational from a logistical point of view and can be purchased by the states at a reasonable price. However, solving the supply problem will be futile if we fail to stimulate demand so that the effective vaccination rate is as high as possible. For this, it is essential to understand both how the potential vaccination subjects behave ‒guided by their beliefs, their perceptions about safety and risk and by their cognitive biases‒ and in what way we can influence that behaviour to guide them towards the socially desirable direction that allows the reduction of disease incidence. 

Monday, 18 October 2021

Risk-based medicine, a hieroglyph full of traps

Jordi Varela


Gerd Gigerenzer, Director of the Harding Center for Risk Literacy at the Max Plank Institute for Human Development in Berlin, was featured in this blog in 2016 following the publication of "Risk Savvy. How to make good decisions." Gigerenzer's crusade against risk manipulation and its consequences are consistent and tenacious, and that's why we should use more of his materials to help overcome the traps of malicious numbers if we want to practice proportionate medicine to address the real risks to peoples health. The following video which was edited in February 2020 by the Gigerenzer factory,  turns out to be essential in differentiating between absolute risk and relative risk.