Analysis on the willingness and influencing factors of choosing primary healthcare institutions among patients with chronic conditions in China: a cross-sectional studyTeng, Li; Li, Yueping
doi: 10.1136/bmjopen-2021-054783pmid: 35354622
ObjectiveTo assess the willingness and factors influencing the choice of primary healthcare (PHC) institutions among patients with chronic conditions in China.DesignA nationwide population-based study with binary logistic regression was conducted and used to estimate the ORs of the influencing factors of health-seeking at PHC institutions using the Anderson model as a theoretical framework.SettingThe China Family Panel Studies (CFPS) database.ParticipantsThe study sample included 7967 patients with chronic conditions identified from the 2016 and 2018 CFPS databases.ResultsFrom 2016 to 2018, the rate of choosing PHC institutions for patients with chronic conditions dropped from 51.0% to 47.7%. The logistic regression results showed that patients with low family income (OR value of >60 000 group was 0.57, 95% CI 0.43 to 0.74), low education level (OR value of bachelor degree or above was 0.54, 95% CI 0.35 to 0.83;), older age (OR value of >65 group was 1.31, 95% CI 1.08 to 1.60;), hypertension and diabetes (OR 1.26, 95% CI 1.13 to 1.41), living in rural areas (OR value of urban was 0.47, 95% CI 0.38 to 0.60), immigrating from rural to urban areas (OR 1.64, 95% CI 1.26 to 2.13), reporting good health (OR value of very good was 1.33, 95% CI 1.05 to 1.68) and those from areas with a high proportion of PHC institutions (OR 1.05, 95% CI 1.02 to 1.07) were more inclined to choose PHC institutions. Conversely, patients with urban employee health insurance (OR 0.62, 95% CI 0.49 to 0.80) and more than one chronic disease (OR 0,83, 95% CI 0.75 to 0.92) preferred choosing a hospital.ConclusionsThe patients’ willingness to choose PHC institutions was low. The health-seeking preference of patients with chronic conditions is derived from medical needs and is influenced by the predisposing factors and tendencies of enabling resources. Measures should be taken to improve the capacity of PHC institutions.
Effect of systemic bisphosphonate administration on patients with periodontal disease: a systematic review and meta-analysis protocolKoide, Yoko; Kataoka, Yu; Hasegawa, Takeshi; Ota, Erika; Noma, Hisashi
doi: 10.1136/bmjopen-2021-057768pmid: 35246424
IntroductionPeriodontal disease is a chronic oral infectious disease affecting adults worldwide as well as a lifestyle-related disease related to diabetes. Bisphosphonate is a drug often taken by patients with osteoporosis; however, it reportedly can cause jawbone necrosis. Due to its mechanism of action on bone tissue, bisphosphonate has been used topically on periodontal tissue to treat periodontal disease. However, the long-term systemic effects of bisphosphonates on periodontal tissues are unclear. This paper describes a protocol evaluating the effects of systemic bisphosphonate administration to prevent periodontal tissue destruction in patients with periodontal disease. No systematic review has attempted to summarise the evidence for systemic bisphosphonates in periodontal therapy. The results of the proposed systematic review will inform the practice and design of future clinical trials.Methods and analysisThis paper describes a protocol for a systematic review of the relevant published analytic research using an aggregative thematic approach according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. Two authors will perform a comprehensive search for studies on Medline/PubMed, Scopus, Embase, LILACS and the Cochrane Central Register of Controlled Trials databases. Abstract screening, full-text screening and data extraction will be performed independently by two authors. A meta-analysis will be conducted as appropriate.Ethics and disseminationThe protocol of this systematic review will be provided in a peer-reviewed journal. Formal ethics approval is not necessary because researchers will not identify individuals in the report.PROSPERO registration numberCRD42020212698 (http://www.crd.york.ac.uk/PROSPERO/).
Development and validation of clinical prediction models for breast cancer incidence and mortality: a protocol for a dual cohort studyClift, Ashley Kieran; Hippisley-Cox, Julia; Dodwell, David; Lord, Simon; Brady, Mike; Petrou, Stavros; Collins, Gary S.
doi: 10.1136/bmjopen-2021-050828pmid: 35351695
IntroductionBreast cancer is the most common cancer and the leading cause of cancer-related death in women worldwide. Risk prediction models may be useful to guide risk-reducing interventions (such as pharmacological agents) in women at increased risk or inform screening strategies for early detection methods such as screening.Methods and analysisThe study will use data for women aged 20–90 years between 2000 and 2020 from QResearch linked at the individual level to hospital episodes, cancer registry and death registry data. It will evaluate a set of modelling approaches to predict the risk of developing breast cancer within the next 10 years, the ‘combined’ risk of developing a breast cancer and then dying from it within 10 years, and the risk of breast cancer mortality within 10 years of diagnosis. Cox proportional hazards, competing risks, random survival forest, deep learning and XGBoost models will be explored. Models will be developed on the entire dataset, with ‘apparent’ performance reported, and internal-external cross-validation used to assess performance and geographical and temporal transportability (two 10-year time periods). Random effects meta-analysis will pool discrimination and calibration metric estimates from individual geographical units obtained from internal-external cross-validation. We will then externally validate the models in an independent dataset. Evaluation of performance heterogeneity will be conducted throughout, such as exploring performance across ethnic groups.Ethics and disseminationEthics approval was granted by the QResearch scientific committee (reference number REC 18/EM/0400: OX129). The results will be written up for submission to peer-reviewed journals.
Fighting COVID-19: a qualitative study into the lives of intensive care unit survivors in Wuhan, ChinaWu, Dong; Ding, Hanyue; Lin, Jiaye; Xiao, Meng; Xie, Jing; Xie, Feng; Zhang, Shuyang
doi: 10.1136/bmjopen-2021-055365pmid: 35351715
ObjectivesWe aimed to provide an insight into the life of survivors of critical COVID-19 in China.MethodsWe conducted an online survey and qualitative interviews among intensive care unit survivors of critical COVID-19 between November and December 2020 in Wuhan, China. Eligible participants were asked to complete the EQ-5D-5L and the Short Form 36-Item Survey, and invited to participate in a semistructured face-to-face interview. Descriptive analyses and phenomenological approach were adopted to analyse quantitative and qualitative data, respectively.ResultsOf 10 survivors who completed the questionnaire, 8 participated in the interview. The mean scores±SD of EuroQol-5 Dimensions-5 Level utility and EuroQol-Visual Analogue Scale were 0.88±0.15 and 80.9±14.2, respectively. The qualitative interview identified four themes, namely poor physical health, post-traumatic stress, social stigma and family support.ConclusionsCOVID-19 survivors continue fighting physical and psychological impacts. Despite strong family support, these patients are struggling with social stigma. It is a long, challenging journey to recovery for patients and society.
Patient, physician and geographic predictors of cardiac stress testing strategy in Ontario, Canada: a population-based studyRoifman, Idan; Han, Lu; Fang, Jiming; Chu, Anna; Austin, Peter; Ko, Dennis T; Douglas, Pamela; Wijeysundera, Harindra
doi: 10.1136/bmjopen-2021-059199pmid: 35273065
ObjectivesTo identify patient, physician and geographic level factors that are associated with variation in initial stress testing strategy in patients evaluated for chest pain.DesignRetrospective cohort study.SettingPopulation-based study of patients undergoing evaluation for chest pain in Ontario, Canada between 1 January 2011 and 31 March 2018.Participants103 368 patients who underwent stress testing (graded exercise stress testing (GXT), stress echocardiography (stress echo) or myocardial perfusion imaging (MPI)) following evaluation for chest pain.Primary and secondary outcome measuresTo identify the patient, physician and geographic level factors associated with variation in initial test selection, we fit two separate 2-level hierarchical multinomial logistic regression models for which the outcome was initial stress testing strategy (GXT, MPI or stress echo).ResultsThere was significant variability in the initial type of stress test performed, with approximately 50% receiving a GXT compared with approximately 36% who received MPI and 14% who received a stress echo. Physician-level factors were key drivers of this variation, accounting for up to 59.0% of the variation in initial testing. Physicians who graduated medical school >30 years ago were approximately 45% more likely to order an initial stress echo (OR 1.45, 95% CI 1.17 to 1.80) than a GXT. Cardiovascular disease specialists were approximately sevenfold more likely to order an initial MPI (OR 7.35, 95% CI 5.38 to 10.03) than a GXT. Patients aged >70 years were approximately fivefold more likely to receive an MPI (OR 4.74, 95% CI 4.42 to 5.08) and approximately 26% more likely to receive a stress echo (OR 1.26, 95% CI 1.15 to 1.38) than a GXT.ConclusionsWe report significant variability in initial stress testing strategy in Ontario. Much of that variability was driven by physician-level factors that could potentially be addressed through educational campaigns geared at reducing this variability and improving guideline adherence.
Developing an interprofessional learning and working culture to improve person-centred care in nursing homes: a realist action research protocolVerbeek, Frank H O; Lovink, Marleen H; Laurant, Miranda G H; van Vught, Anneke J A H
doi: 10.1136/bmjopen-2021-058319pmid: 35321897
IntroductionHealthcare is changing due to the ageing of the general population, complex care demands and growing attention to person-centred care. To deal with these changes and provide the best possible person-centred care, the different professionals in nursing homes should all collaborate intensively. However, most professionals work within the field of their own expertise and share very little knowledge, experiences and insights. A lack of an interprofessional learning and working culture also prevents professionals with different expertise from working and learning intensively together to achieve high-quality person-centred care. There is a gap of knowledge about how to develop such a culture. Our aim is to provide insights into what actions, in what context and to what extent can contribute to an impactful development of an interprofessional learning and working culture.Methods and analysisThe realist action research design will be applied. It consists of three iterative steps: plan, act and observe, and reflect. First, we will formulate the theory about interprofessional learning and working culture and measure this culture by means of interviews, focus groups and questionnaires. Second, we will apply the nine principles of Practice Development to coach professionals from six Dutch nursing homes to improve their interprofessional learning and working culture. Finally, we will evaluate the impact of the changed attitudes and skills on healthcare practice.Ethics and disseminationApproval for the project was given by the Hogeschool van Arnhem en Nijmegen (HAN) Research Ethics Committee, the Netherlands, registration number EACO 164.12/19. All organisations, professionals and residents/family members will be informed verbally and by letter about the study and asked for informed consent. The results will be presented in peer-reviewed scientific journals, professional journals and at symposia and conferences. The findings will be transferred to an online toolbox and e-learning modules for graduated professionals and students.
Primary Care Severe Asthma Registry and Education Project (PCSAR-EDU): Phase 1 – an e-Delphi for registry definitions and indices of clinician behaviourD'Urzo, Katrina A; Tamari, Itamar E; Chapman, Kenneth R; Maleki-Yazdi, M Reza; Greiver, Michelle; Upshur, Ross EG; Biro, Lana; O'Neill, Braden; Moineddin, Rahim; Aliarzadeh, Babak; Kulasegaram, Kulamakan; To, Teresa; D'Urzo, Anthony D
doi: 10.1136/bmjopen-2021-055958pmid: 35332043
IntroductionAlthough most asthma is mild to moderate, severe asthma accounts for disproportionate personal and societal costs. Poor co-ordination of care between primary care and specialist settings is recognised as a barrier to achieving optimal outcomes. The Primary Care Severe Asthma Registry and Education (PCSAR-EDU) project aims to address these gaps through the interdisciplinary development and evaluation of both a ‘real-world’ severe asthma registry and an educational programme for primary care providers. This manuscript describes phase 1 of PCSAR-EDU which involves establishing interdisciplinary consensus on criteria for the: (1) definition of severe asthma; (2) generation of a severe asthma registry and (3) definition of an electronic-medical record data-based Clinician Behaviour Index (CBI).Methods and analysisIn phase 1, a modified e-Delphi activity will be conducted. Delphi panellists (n≥13) will be invited to complete a 30 min online survey on three separate occasions (i.e., three separate e-Delphi ‘rounds’) over a 3-month period. Expert opinion will be collected via an open-ended survey (‘Open’ round 1) and 5-point Likert scale and ranking surveys (‘Closed’ round 2 and 3). A fourth and final Delphi round will occur via synchronous meeting, whereby panellists approve a finalised ideal ‘core criteria list’, CBI and corresponding item weighting.Ethics and disseminationEthical approval has been obtained for the activities involved in phase 1 from the University of Toronto’s Human Research Ethics Programme (approval number 39695). Future ethics approvals will depend on information gathered in the proceeding phase; thus, ethical approval for phase 2 and 3 of this study will be sought sequentially. Findings will be disseminated through conference presentations, peer-reviewed publications and knowledge translation tools.