BACKGROUND AND OBJECTIVE

In the Philippines, patients are constrained from accessing their own records, restricting their ability to freely choose who to seek care from. To address this, the study makes a case for the development of the health smart card in the Philippines, an integrative tool unique to each citizen carrying their lifetime medical record.

The prototype is developed using no-code programming technology and validated through a series of focus group discussions and stakeholder consultations with patients (n=4), healthcare administrators (n=4), and hospital personnel (n=13). It was then revised based on the collected insights and recommendations.

Findings report that the current facility-centric model utilizing paper records constrains patients’ access to their records due to long wait times, slow turnaround periods, constant intra- and inter-hospital transfers, and even charging of fees to acquire a copy of their own data. The health smart card alternative was widely accepted by the participants, particularly for its contribution to increasing data accessibility, patient empowerment, and advancing patient data ownership. Nevertheless, several considerations for the upscale implementation of the health smart card emerged, including creating an interoperable environment through harmonizing standards and capacity-building programs, and ensuring data security through robust cybersecurity measures. Issues on scalability and funding of the project were also raised, centering on the critical role of the government in stepping up as regulator and potential funder. Concerns over potential abuse, dataveillance, and the digital divide are tackled, highlighting the need to account for socioeconomic factors to ensure that no one is left behind in the implementation.

The study makes a case for the development and adoption of a health smart card to address the inaccessibility of records to patients. The study concludes by recommending the conduct of a pilot implementation to comprehensively demonstrate and analyze the features of the proposed scheme.

BACKGROUND

Advance care planning (ACP) discussions are vital, but they remain largely neglected and met with resistance in the Philippines. The general population, especially non-medical individuals, has not actively engaged in ACP. To address this, we developed the ‘ACP-READY’ program for primary care settings.

This study aimed to assess the effectiveness of ‘ACP-READY’ in facilitating the completion of Advance Directives (ADs) among non-medical personnel and identifying barriers to their completion.

A randomized, controlled, single-blind approach with a quantitative survey followed by qualitative semi-structured interviews enrolled 161 English-literate, legally competent individuals aged 18-65 from a hospital’s non-medical staff. Participants were randomly assigned to control (n=77) or intervention (n=84) groups. We initially evaluated participants’ readiness for ACP (ACPRe)1. Subsequently, both groups were instructed to complete an AD form in their preferred language, with the experimental group receiving an interactive ACP seminar. Post-test assessments gauged participants’ willingness to complete their AD. A focused-group discussion was conducted to explore their experiences.

Baseline characteristics were similar between groups. There was no statistical difference in readiness improvement and AD completion rates between the control and intervention groups. Well-worded brief instruction and comprehensive seminars were equally effective in enhancing readiness and promoting AD completion (pCONCLUSION

Concise and well-presented instruction on ACP is as effective as comprehensive seminars in promoting AD completion among medically stable individuals. Family physicians, with their longitudinal, patient-centered approach, can address some of the identified barriers.

Objectives: Majority of the existing patient safety culture tools are designed for healthcare workers. Despite the claims that this patient safety tools are patient-centered, limited attention was given to the patients’ perspectives and cultural considerations in the development. Local studies are not available in extant literature that capture patient perspectives on being safe during hospitalization. The goal of the study was to develop and provide preliminary psychometric analysis on a tool that measures patients’ perception of safety culture in a hospital setting. Methods: The study was a quantitative methodological study. The instrument was developed in three phases, conceptualization and item generation through literature review, clinical observation, and focus group discussion, two rounds of expert panel review, and pilot testing. The tool was tested on 122 eligible patients admitted in a tertiary hospital. Factor analysis of the items was done to determine the underlying factor under each item. Cronbach’s alpha was used to test the degree of internal consistency of the scale. Results: The Patient Perceptions on Safety Culture in Hospital Setting Scale consists of 25 items. The analysis yielded four factors explaining a total of 69.23% of the variance in the data. Items were grouped in four dimensions: Hospital workforce (4 items), Hospital Environment (5 items), Heath Management and Care Delivery (7 items), and Information Exchange (9 items). Each factor registered a Cronbach’s alpha of 0.81, 0.78, 0.91, 0.94, respectively. The overall Cronbach’s alpha of the scale is 0.95. Conclusion The study offers preliminary evidence on the psychometric properties of a newly developed tool that measures patient perceptions on hospital safety culture. Subsequent studies on larger samples need to be conducted to determine the reliability and validity of the tool when applied to different population and contexts as well as determining valid cut-off points in scoring and interpretation.
Patient Safety ; Patient Participation

Background and Objective: In the Philippines, patients are constrained from accessing their own records, restricting their ability to freely choose who to seek care from. To address this, the study makes a case for the development of the health smart card in the Philippines, an integrative tool unique to each citizen carrying their lifetime medical record. Methods: The prototype is developed using no-code programming technology and validated through a series of focus group discussions and stakeholder consultations with patients (n=4), healthcare administrators (n=4), and hospital personnel (n=13). It was then revised based on the collected insights and recommendations. Results: Findings report that the current facility-centric model utilizing paper records constrains patients’ access to their records due to long wait times, slow turnaround periods, constant intra- and inter-hospital transfers, and even charging of fees to acquire a copy of their own data. The health smart card alternative was widely accepted by the participants, particularly for its contribution to increasing data accessibility, patient empowerment, and advancing patient data ownership. Nevertheless, several considerations for the upscale implementation of the health smart card emerged, including creating an interoperable environment through harmonizing standards and capacity-building programs, and ensuring data security through robust cybersecurity measures. Issues on scalability and funding of the project were also raised, centering on the critical role of the government in stepping up as regulator and potential funder. Concerns over potential abuse, dataveillance, and the digital divide are tackled, highlighting the need to account for socioeconomic factors to ensure that no one is left behind in the implementation. Conclusion The study makes a case for the development and adoption of a health smart card to address the inaccessibility of records to patients. The study concludes by recommending the conduct of a pilot implementation to comprehensively demonstrate and analyze the features of the proposed scheme.
health smart card ; patient empowerment ; patient participation ; Philippines

Background: Shared decision-making (SDM) is the active process of collaborative clinical decision making between patient and physician. Factors associated with use of shared decision making have been investigated previously, but few have explored this topic locally. Objective: To determine patient and physician characteristics associated with shared decision making of adult Filipino patients with type 2 diabetes mellitus. Methods: A cross sectional study was conducted from January to April 2020 among patients of the Family Medicine Clinic (FMC) of the Philippine General Hospital (PGH) with type 2 diabetes mellitus and all residents of the Department of Family and Community Medicine (DFCM). Sociodemographic characteristics and clinical characteristics were obtained using self-administered questionnaires, and shared decision making was measured using the SDM Q-9 Filipino Version. Responses were encoded using Microsoft Excel and analyzed using SPSS. Results: A total of 153 patients and 36 residents were recruited into the study. The patients had an average age of 59 (SD + 9.52) years, with the majority being female (68.6%), and a mean HbA1c level of 7.76% (SD + 2.53%). The physicians had an average age of 29.6 (SD + 4.59) years, and more than half were female (66.67%). The mean level of perceived shared decision making was 85.77% (SD + 14.12%). Patients who were not aware of the current HbA1c level were less likely to have high shared decision making, while having two or less comorbidities increased the likelihood of having a highly participative consultation. Conclusion The perceived mean shared decision making was 85.77%. Shared decision making was associated with lack of knowledge on HbA1c level and few comorbidities among adult Filipino patients with Type 2 diabetes mellitus at the Family Medicine Clinic of the Outpatient Department of the Philippine General Hospital. None of the physician characteristics were linked to patient participation.
Decision Making, Shared ; Patient Participation ; Diabetes Mellitus

PURPOSE: Geographical analysis is becoming a powerful tool for evaluating the quality of medical services and acquiring fundamental data for medical decision-making. Using geographical analysis, we evaluated the impact of the distance from patients' homes to the hospital on their participation in outpatient cardiac rehabilitation (OCR). METHODS: All patients hospitalized for percutaneous coronary intervention, coronary artery bypass grafting, valvular surgery, congestive heart failure, and aortic diseases were advised to participate in an OCR program after discharge. Using the dataset of our cohort study of OCR from 2004 to 2015 (n = 9,019), we used geographical analysis to investigate the impact of the distance from patients' homes to hospital on their participation in our OCR program. RESULTS: Patients whose road distance from home to hospital was 0-10 km, 10-20 km, and 20-30 km participated more in OCR than those whose road distance was ≧ 30 km (OR 4.34, 95% CI 3.80-4.96; OR 2.98, 95% CI 2.61-3.40; and OR 1.90, 95% CI 1.61-2.23, respectively). Especially in patients with heart failure, the longer the distance, the lesser the participation rate (P < .001). CONCLUSIONS: Using geographical analysis, we successfully evaluated the factors influencing patients' participation in OCR. This illustrates the importance of using geographical analysis in future epidemiological and clinical studies. TRIAL REGISTRATION UMIN000028435.
Aged ; Aged, 80 and over ; Cardiac Rehabilitation/statistics & numerical data* ; Female ; Geography ; Humans ; Japan ; Male ; Middle Aged ; Outpatients/statistics & numerical data* ; Patient Participation/statistics & numerical data* ; Prospective Studies ; Spatial Analysis

With the continuous improvement of modern medical technology, medical practice has become more and more procedural. The medical process is often dominated by doctors, while the value orientation of patients is often ignored, lacking effective communication between doctors and patients. In response to this phenomenon, Charon R proposed the concept of narrative medicine, which has been recognized by all walks of life. In recent years, the value of medical humanism has attracted more attention, and the research on narrative medicine at home and abroad is increasing gradually. But at present, most of the research on narrative medicine is in terms of theory, lacking clinical research. How to make narrative medicine applied in the real world is the focus of current research. Following the concept of narrative medicine, and taking the study on doctor-patient parallel medical record to evaluate the real clinical efficacy of traditional Chinese medicine(TCM) and Western medicine(WM) in the treatment of digestive diseases as an example, this study is to explore the design contents and key points of the clinical trial scheme of doctor-patient co-construction of TCM and WM under narrative medicine, and discuss the activity form and clinical efficacy evaluation method under narrative medicine. Clinical trial design includes four aspects: medicine, ethics, statistics and trial management. This study explored the design of the doctor-patient co-construction clinical trial scheme under narrative medicine from both theoretical and practical aspects, providing reference for the design and research of future doctor-patient co-construction scheme, and expecting to establish a better efficacy evaluation method of TCM and WM.
Clinical Trials as Topic ; Humans ; Medical Records ; Medicine, Chinese Traditional ; Narrative Medicine ; Patient Participation ; Research Design

PURPOSE: This study was to investigate patient safety perception and patient participation, and to provide basic data for the development of patient participation education programs.METHODS: The subjects of this study were 183 patients with at least one experience of the Hemato-oncology Department at a tertiary hospital in Seoul. Data were collected from April 11, 2019 to May 7, 2019 using structured questionnaires including patient safety perception and patient participation.RESULTS: The patient safety perception score was 4.23±0.48 out of 5. The patient participation score was 4.30±0.53 out of 5. Patient safety perception was significantly different according to age (p=.008), education (p=.045), employment status (p=.031), marital state (p=.037), medical department (p=.004), comorbidity (p=.046), and patient participation education (p=.010). Patient participation was significantly difference in age (p=.020), education (p=.004) and employment status (p=.005). The correlation between the patient safety perception and patient participation was statistically significant (r=.75, p < .001).CONCLUSION: It is necessary to improve the system for medical staff, patients and medical institutions in order to enable patients to communicate with medical staff in a satisfactory manner and participate in patient safety activities.
Comorbidity ; Education ; Employment ; Humans ; Medical Staff ; Patient Participation ; Patient Safety ; Seoul ; Tertiary Care Centers

PURPOSE: This study's aim was to examine degrees of patient participation in patient safety activities in hospitals and to investigate their relationships with nurses' patient-centered care competency (PCC), teamwork, and safety climate. METHODS: A cross-sectional study designwas used. Data were collected with 479 nurses from two general hospitals in Seoul, Korea, using a questionnaire designed to collect data on patient participation in patient safety activities, PCC, teamwork perceptions, and safety climate. The response rate was 74.1% (N = 355). Data were analyzed using descriptive statistics and multiple logistic regression analysis. RESULTS: The mean score for patient participation was 2.76 ± 0.46 of 4.0. The mean scores for PCC, teamwork, and safety climate were 3.61 ± 0.46, 3.64 ± 0.41, and 3.35 ± 0.57 of 5.0, respectively. Nurses who experienced high patient participation in patient safety activities (≥ 3.0) had higher scores for PCC, teamwork, and safety climate. Multiple logistic regression analysis revealed that PCC (OR = 2.31, 95% CI = 1.14–4.70) and safety climate (OR = 2.51, 95% CI = 1.09–5.78) scores were the significant factors associated with patient participation. CONCLUSION: The degree of patient participation in patient safety activities was not high. Nurses' PCC, teamwork, and safety climate were positively related with patient participation. In particular, the findings indicate that enhancing nurses' competency for patient-centered care and creating a strong safety climate are important to promote patient participation for safer health care.
Climate ; Cross-Sectional Studies ; Delivery of Health Care ; Hospitals, General ; Humans ; Korea ; Logistic Models ; Patient Participation ; Patient Safety ; Patient-Centered Care ; Seoul ; Surveys and Questionnaires

BACKGROUND/AIMS: TrueColours ulcerative colitis (TCUC) is a comprehensive web-based program that functions through email, providing direct links to questionnaires. Several similar programs are available, however patient perspectives are unexplored. METHODS: A pilot study was conducted to determine feasibility, usability and patient perceptions of real-time data collection (daily symptoms, fortnightly quality of life, 3 monthly outcomes). TCUC was adapted from a web-based program for patients with relapsing-remitting bipolar disorder, using validated UC indices. A semi-structured interview was developed and audio-recorded face-to-face interviews were conducted after 6 months of interaction with TCUC. Transcripts were coded in NVivo11, a qualitative data analysis software package. An inductive approach and thematic analysis was conducted. RESULTS: TCUC was piloted in 66 patients for 6 months. Qualitative analysis currently defies statistical appraisal beyond “data saturation,” even if it has more influence on clinical practice than quantitative data. A total of 28 face-to-face interviews were conducted. Six core themes emerged: awareness, control, decision-making, reassurance, communication and burden of treatment. There was a transcending overarching theme of patient empowerment, which cut across all aspects of the TCUC experience. CONCLUSIONS: Patient perception of the impact of real-time data collection was extremely positive. Patients felt empowered as a product of the self-monitoring format of TCUC, which may be a way of improving self-management of UC whilst also decreasing the burden on the individual and healthcare services.
Automatic Data Processing ; Bipolar Disorder ; Colitis, Ulcerative ; Data Collection ; Delivery of Health Care ; Electronic Mail ; Humans ; Patient Participation ; Pilot Projects ; Quality of Life ; Self Care ; Statistics as Topic ; Ulcer